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MERS CoV Prevention

The document is a training manual focused on controlling the spread of MERS-CoV in Saudi hospitals, emphasizing the lack of vaccines or treatments and the necessity for strict infection control measures. It outlines ten critical steps for healthcare workers to combat the virus, including maintaining personal hygiene, proper use of PPE, early identification and isolation of suspected patients, and appropriate housekeeping practices. The manual also details protocols for handling potential MERS-CoV patients and disposing of contaminated materials to enhance safety in hospital settings.

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MERS-CoV infection control Classroom session-Clinical MoH Training Manual – v1.6 20140901
Doc ID 1 MoH Training Manual – v1.6 20140901 We are here to stop the spread of MERS-CoV by fixing infection prevention and control in Saudi hospitals ▪ No vaccine ▪ No treatment ▪ High death rate ▪ Highly contagious in a hospital setting ▪ Hospital staff at high risk if not following infection control rules Strict infection control is the only way to stop MERS-CoV from spreading – everyone of us is responsible and can help to stop the disease
Doc ID 2 MoH Training Manual – v1.6 20140901 Your 10 steps to fight MERS-CoV in your hospital 1. Maintain strict personal hygiene 2. Ensure proper use of PPE by staff and patient 3. Identify and isolate potential MERS-CoV patients early 4. Allocate adequate facilities for MERS-CoV patients 5. Follow appropriate housekeeping practices 6. Monitor staff health – don’t allow sick people at work 7. Implement stricter visitor policy 8. Send for home isolation under supervision, when possible 9. Ensure safe collection and handling of lab samples 10. Take precautions in the mortuary
Doc ID 3 MoH Training Manual – v1.6 20140901 1. MAINTAIN STRICT PERSONAL HYGIENE You already know this, you just need to DO IT EVERY DAY Cough etiquette Short nails, no watches, no jewelry Other basics 11 10 2 FRI 16 ▪ Avoid touching your face ▪ Avoid touching patient’s items ▪ Do not share personal items ▪ Shower after work ▪ Change uniform daily ▪ Keep home clean and ventilated ▪ If you feel sick, do not come to work – tell your senior over phone ▪ Avoid contact with sick colleagues SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; the Infection Control powerpoint 12 6 9 3 1 4 5 7 8 TIMEZ INDIGLO WR30M 
Doc ID 4 MoH Training Manual – v1.6 20140901 More on hand hygiene When to do it?  5 moments of hand hygiene  When hands are visibly soiled  After contact with a source of microorganisms (body fluids and substances, mucous membranes, non-intact skin, surfaces that are likely to be contaminated)  After removing gloves and before wearing them.  Before and after smoking, eating or preparing food  Before leaving the patient’s room  After bodily functions (e.g., using the toilet, blowing one’s nose, sneezing)  When moving from a contaminated body site to a clean body site during patient care SOURCE: WHO; Saudi Aramco John Hopkins How to do it? Use proper hand hygiene technique to disinfect all parts of your hands 1. MAINTAIN STRICT PERSONAL HYGIENE
Doc ID 5 MoH Training Manual – v1.6 20140901 1. MAINTAIN STRICT PERSONAL HYGIENE Correct technique – how to handrub and handwash (1/3) Alcohol-based handrub is more efficient than handwash when hands are not soiled SOURCE: WHO; Saudi Aramco John Hopkins
Doc ID 6 MoH Training Manual – v1.6 20140901 1. MAINTAIN STRICT PERSONAL HYGIENE SOURCE: WHO
Doc ID 7 MoH Training Manual – v1.6 20140901 Hand washing Technique
Doc ID 8 MoH Training Manual – v1.6 20140901 2. ENSURE PROPER USE OF PPE BY STAFF AND PATIENTS Droplet and contact precautions required when dealing with potential MERS-CoV patients; N95 to be worn during aerosol generating procedures Potential/confirmed MERS-CoV: in patient’s room/close contact – contact and droplet precautions (for healthcare workers and visitors) ▪ Surgical mask (N95 for aerosol generating procedures) ▪ Eye protection (goggles/face shield) ▪ Gown (clean, non-sterile, long-sleeved) ▪ Gloves (some procedure may require sterile gloves) ▪ Impermeable apron (for procedures with expected splashes) May be considered if resources permit: ▪ Airborne precautions with all potential/confirmed MERS-CoV patients (N95) ▪ Surgical mask for all fever/respiratory patients at the ER entrance Safely remove PPE and perform hand hygiene when leaving the MERS-CoV precautions area (e.g., isolation or procedure room) SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; CDC pictures
Doc ID MoH Training Manual – v1.6 20140901 9 2. ENSURE PROPER USE OF PPE BY STAFF AND PATIENTS N95 provides protection only if appropriately used Do not use N95 with valves  …When working in a sterile field such as an operating room Conduct fit test for your N95  N-95 mask comes in different sizes and offers no protection if not properly fitted  Fit test has to be performed for employees wearing N95 to ensure proper fit How to fit test N95 mask: https://www.youtube.com/watch?v=7IAsoU6h-8g Never wear a medical mask under the N95 mask as this prevents proper fitting and sealing of the N95 mask thus decreasing its efficacy. Source: Saudi Aramco Johns Hopkins Inspect your N95 every time before wearing ▪ For structural integrity ▪ Ensure that the straps are not cut or damaged ▪ Make sure the metal nose clip is in place and functions properly ▪ Determine if it is physically damaged or soiled How to wear N95 mask: http://www.youtube.com/watch?v=bo-PEzHE7iw
Doc ID 10 Extended Use of N95 Filtering, face piece, respirators in healthcare settings: Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several patients, without removing the respirator between patient encounters. Extended use may be implemented when multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards. * Discard N95 respirators following use during aerosol generating procedures. * Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients. * Perform hand hygiene with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).
Doc ID 11 Reuse of N95 filtering, face piece, respirators in Health care settings Reuse refers to the practice of using the same N95 respirator for multiple encounters with patients but removing it (“doffing”) after each encounter. The respirator is stored in between encounters to be put on again (“donned”) prior to the next encounter with a patient. • Discard N95 respirators following use during aerosol generating procedures. • Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients. *Store respirators in a single disposable paper container with identification. •Clean hands with soap and water or an alcohol-based sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).
Doc ID 12 Reuse continued: •Clean hands with soap and water or an alcohol-based sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit). Clean hands with soap and water or an alcohol-based sanitizer after donning a used N95 respirator and performing a user seal check. • Follow the manufacturer’s user instructions, including conducting a user seal check. • Maximum number of donning up to five times if the manufacturer does not provide a recommendation. • Discard any respirator that is obviously damaged or becomes hard to breathe through. *Pack or store respirators between uses so that they do not become damaged or deformed.
Doc ID MoH Training Manual – v1.6 20140901 13 Veil and beard with the N95 mask VEIL For female staff who wear veils, the medical or N95 mask should always be placed directly on the face behind the veil and not over the veil. In this instance a face shield should also be used along with the mask. BEARD N95 does not provide full protection for people with beards – use alternative respirator such as powered air purifying respirator, should be used.
MoH Training Manual – v1.6 20140901 SEQUENCE FOR DONNING PERSONAL PROTECTIVE EQUIPMENT ( PPE ) The type of PPE used will vary based on the level of precautions required: e.g., Standard and Contact, Droplet or Airborne Infection Isolation. 1. GOWN • Fully cover torso from neck to knees, arms to end of wrists • , and wrap around the back • Fasten in back of neck and waist 2. MASK OR RESPIRATOR • Secure ties or elastic bands at middle of head and neck • Fit flexible band to nose bridge • Fit snug to face and below chin • Fit-check respirator 3. GOGGLES OR FACE SHIELD • Place over face and eyes and adjust to fit 4. GLOVES • Extend to cover wrist of isolation gown USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION ■ Keep hands away from face ■ Limit surfaces touched ■ Change gloves when torn or heavily contaminated ■ Perform hand hygiene Putting on PPE: http://www.youtube.com/watch?v=HIR88sJEI2s SOURCE: CDC (http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf)
MoH Training Manual – v1.6 20140901 SEQUENCE FOR DOFFING ( removing ) PERSONAL PROTECTIVE EQUIPMENT ( PPE ) Except for respirator, remove PPE at doorway or inside the patient’s room. Remove respirator after leaving patient room and closing door (anteroom). 1. GLOVES • Outside of gloves is contaminated! • Grasp outside of glove with opposite gloved hand; peel off • Hold removed glove in gloved hand • Slide fingers of ungloved hand under remaining glove at wrist • Peel glove off over first glove • Discard gloves in waste container *Perform Hand Hygiene* WHO STATES HAND HYGIENE BEFORE PUTTING ON GLOVES AND IMMEDIATELY AFTER REMOVING GLOVES 2. GOGGLES OR FACE SHIELD • Outside of goggles or face shield is contaminated! • To remove, handle by head band or ear pieces • Place in designated receptacle for reprocessing or in waste container 3. GOWN • Gown front and sleeves are contaminated! • Unfasten ties • Pull away from neck and shoulders, touching • inside of gown only • Turn gown inside out • Fold or roll into a bundle and discard *Perform Hand Hygiene* 4. MASK OR RESPIRATOR ( done outside of the room ) • Front of mask/respirator is contaminated — • DO NOT TOUCH! • Grasp bottom, then top ties or elastics and remove • Discard in waste container HAND HYGIENE COULD BE PERFORMED AFTER EVERY STEP OF REMOVAL OF SUSPECTED CONTAMINATED PPE SOURCE: CDC (http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf) Taking off PPE: http://www.youtube.com/watch?v=vYMWTWE4xqU
Doc ID 16 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Promptly identify symptomatic patients at the hospital entry and take MERS-CoV precautions until recovery, regardless of test results Patients with fever, ARI1, diarrhea and other Take precautions for MERS-CoV ▪ PPE for staff and source control for patient ▪ Isolation2 Test for other pathogens. If patient meets MERS-CoV case definition, also test for MERS-CoV MERS-CoV positive MERS-CoV negative3 Take precautions for MERS-CoV until symptoms resolve ▪ PPE for staff and source control for patient ▪ Isolation2 1 Acute respiratory infections – symptoms including runny nose, sneezing, coughing, shortness of breath 2 In hospital or home 3 And no alternative confirmed diagnosis / still suspicion for MERS – for multiple reasons, negative tests do not fully rule out possibility of MERS-CoV SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014 When possible ▪ Identify symptomatic patients at the hospital entrance ▪ Allocate a separate room/area in ER for symptomatic patients ▪ Allocate separate procedure rooms for symptomatic patients ▪ Restrict visitors and do not rotate personnel in high risk MERS-CoV area
Doc ID 17 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS MERS-CoV case definition has to be followed when testing for MERS-CoV Suspect case (patients who should be tested for MERS-CoV) I. A person with fever and community-acquired pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence OR II. A hospitalized patient with healthcare associated pneumonia based on clinical and radiological evidence OR III. A person with 1) Acute febrile (≥38°C) illness AND 2) Body aches, headache, diarrhea, or nausea/ vomiting, with or without respiratory symptoms AND 3) Unexplained leucopenia (WBC<3.5x10/L) and thrombocytopenia (platelets<150x10/L) OR IV. A person (including health care workers) who had protected or unprotected exposure to a confirmed or probable case of MERS-CoV infection and who presents with upper or lower respiratory illness within 2 weeks after exposure ▪ A probable case is a patient in category I or II with absent or inconclusive laboratory results for MERS-CoV and other possible pathogens who is a close contact of a laboratory-confirmed MERS-CoV case or who works in a hospital where MERS-CoV cases are cared for ▪ A confirmed case is a person with laboratory confirmation of MERS-CoV infection SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
Doc ID 18 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Triage and screening for MERS-CoV PATIENTS COMING TO THE EMERGENCY ROOM SCREENING FOR MERS SYMPTOMS There should be a separate desk or room outside the ER patient care area, where new patients are screened. Posters for patient to self-triage must be visible here. Visitors must be strictly controlled. The doctor & nurse here should wear surgical masks or N95 and follow general precautions. Send patient to the regular ER triage and waiting area. 1. Put regular mask on patient 2. Shift to isolation room / area 3. Give emergency treatment 4. Test for MERS-CoV 5. Based on clinical assessment, Admit to MERS unit or send home with advice on hand washing, cough etiquette & home isolation MERS SYMPTOMS NO SYMPTOMS Follow MERS case definition criteria to identify cases MERS MANAGEMENT
Doc ID 19 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Decision 1 – Is it an ARI patient (potential MERS)? YES Patient ER reception ▪ Apply standard precautions ▪ Provide the patient with a medical mask ▪ Lead the patient into designated waiting area for ARI patients NO Patient ER reception ▪ Apply standard precautions ▪ Lead the patient into general ER waiting area Do you have any of these: I feel sick. Help me! Patient ER reception Practical tips ▪ Allocate a separate isolated area for ARI patients in your ER ▪ Ensure ER receptionist wears PPE (mask) and performs hand hygiene ▪ Ensure everybody in ARI part of ER wears PPE (masks) and performs hand hygiene ▪ Have signage and displays for patients, provide masks SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014
Doc ID 20 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Decision 2 – Should we test for MERS? Patient CASE DEFINITION CONFIRMED NO CASE DEFINITION Physician SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014 ▪ Take nasopharyngeal swab for MERS-CoV test ▪ Place patient into isolated single room ▪ Treat the patient based on his/her healthcare needs ▪ Keep applying basic precautions (PPE etc.)  Acquire clinical or radiological evidence necessary to confirm MERS case definition Practical tips ▪ All radiological procedure should be done on site as long as possible
Doc ID 21 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Decision 3 – Isolate in the hospital or at home? Test results Physician  Take decision about further patient treatment based on test results, pre-sence of symptoms and patient’s living conditions MERS POSITIVE SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014 ▪ Continue hospital isolation if – Patient has MERS symptoms ▪ Isolate at home1 if – Patient has no MERS symptoms MERS NEGATIVE ▪ Continue hospital isolation if – CD I or II, or – CD III or IV with pneumonia ▪ Isolate at home1 if – CD III or IV without pneumonia 1 Home should be suitable for isolation based on Home Isolation Guidelines – if not suitable, keep in isolation in the hospital
Doc ID 22 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Decision 4 – When to discharge the patient? Hospital isolation Home isolation Patient discharge criteria ▪ Patient is clinically well for 24 hours, and – No clinical concern for viral shedding, or – Repeated MERS CoV test is negative ▪ Repeated weekly test is negative SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014
Doc ID 23 4. ALLOCATE ADEQUATE FACILITIES FOR MERS-CoV PATIENTS1 Place patient in isolation – Patient placement requirement ▪ Place patients with suspected, probable or confirmed MERS-CoV infection who are not critically ill in adequately ventilated single room. ▪ Place patients with suspected, probable or confirmed MERS-CoV infection who are critically ill in a negative pressure room. If not available then single room with HEPA filter. ▪ The rooms used for isolation should be situated in an area that is clearly segregated from other patient-care areas ▪ When single rooms are not available, cohort – put patients with the same lab confirmed diagnosis together (i.e., taking into consideration positive MERS-CoV and other contagious diseases ) ▪ Use HEPA-filters when negative pressure rooms not available ▪ Standard, contact & droplet precautions should be used for all suspected and confirmed patients. ▪ When an AGP is being anticipated air borne precautions should be added MERS-CoV More information: GCC Infection Control Manual GCC-ICM-III-03, 04, 05 1 Both, potential and confirmed SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
Doc ID 24 MoH Training Manual – v1.6 20140901 5. FOLLOW APPROPRIATE HOUSEKEEPING PRACTICES Housekeeping standards and rules should be followed Item sharing Requirements ▪ Use disposable or dedicated equipment when possible ▪ Clean and disinfect shared equipment between patients ▪ Discard single-use devices in a hands-free waste bin House-keeping standards ▪ Comply with the hospital’s standards and GCC Infection Control Manual on all procedures (cleaning, waste etc.) ▪ Follow PPE requirements for MERS-CoV or higher ▪ Use hospital approved disinfectants with approved dilution Areas ▪ Clean all horizontal and frequently touched surfaces (incl. medical equipment) at least twice daily/once a shift ▪ Clean isolation areas last; when possible, change mop head after each isolation room, disinfect after each use ▪ Follow hospital’s terminal cleaning protocol for patient’s room when vacated by the previous patient. Replace curtains when terminal cleaning. SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
Doc ID 25 MoH Training Manual – v1.6 20140901 6. MONITOR STAFF HEALTH – DON’T ALLOW SICK PEOPLE AT WORK Monitor staff health – identify and exclude symptomatic staff from work Recommendations Healthcare facility ▪ Implement flexible non-punitive sick leave policies for staff ▪ Provide staff with quick access to medical consultation and treatment ▪ Screen all staff for MERS-CoV symptoms at the beginning of the shift ▪ Exclude symptomatic staff from work ▪ Dedicate the same staff to MERS-CoV patients ▪ Track staff exposure to MERS-CoV patients ▪ If resources permit, provide separate accommodation for staff with regular exposure to potential/confirmed MERS-CoV patients Staff ▪ In general: – Monitor MERS-CoV symptoms – Report to supervisor if symptomatic ▪ If symptomatic – Do not come to work/stop working immediately – Notify supervisor – Wear surgical mask for source control – Seek prompt medical evaluation – Stay on leave until no longer infectious ▪ If asymptomatic but had unprotected close MERS-CoV exposure – Monitor symptoms – Wear surgical mask for source control (when not wearing N95) – Consider exclusion from work until found non-infectious SOURCE: CDC MERS-CoV recommendations
Doc ID 26 MoH Training Manual – v1.6 20140901 7. IMPLEMENT STRICTER VISITOR POLICY Limit the number of visitors and train them to comply with precautions Visitor management requirement ▪ Limit the number of visitors and family members to those essential for patient support Additional practices if resources permit ▪ Screen visitors for ARI symptoms at the hospital entrance ▪ Evaluate risk to visitors’ health (e.g., due to underlying illness) and ability to comply with precautions ▪ Instruct visitors on hand hygiene, potentially contaminated surfaces, and use of PPE, before entry into the patient care area and supply necessary equipment (e.g., surgical masks) ▪ Track (e.g., via logbook) all visitors to MERS-CoV patient rooms ▪ Allow no visitors during aerosol-generating procedures (and if possible, for one hour after) ▪ Limit visitor movement within the facility (e.g., visitors to MERS-CoV patient rooms should not visit other areas). A security personnel should be assigned outside any unit with suspected or confirmed cases to limit access to isolated patients. 1 Acute respiratory infections SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; CDC MERS-CoV recommendations
Doc ID 27 MoH Training Manual – v1.6 20140901 8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE Patients with no shortness of breath, hypoxemia or pneumonia can be isolated at home, provided home facilities meet the requirements Assess (by phone or direct observation) whether the home is appropriate for isolating the ill person  The home should have a functioning bathroom – ideally, one bathroom should be designated solely for the ill person  The ill person should have his or her own bed and preferably a private room for sleeping  Basic amenities, such as AC, electricity, potable and hot water, sewer, and telephone access, should be available  There should be a primary caregiver who can - Follow doctor’s instructions for medications and care - Help the ill person with basic needs Follow MERS-CoV Home Isolation Guidelines for patient home care requirements SOURCE: KSA MoH MERS-CoV Home Isolation Guidelines, May 2014
Doc ID 28 MoH Training Manual – v1.6 20140901 8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE Home isolated patient needs to follow Separate oneself from other people in the house Call ahead before visiting doctor Wear a medical mask Patient must… Cover coughs and sneezes Avoid sharing household items Wash hands SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014
Doc ID 29 MoH Training Manual – v1.6 20140901 8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE Family and caregivers have to take precautions Health Care Providers Instructions Limit the number of people at home Be aware of them and help the ill person follow them To only essential for providing care for the ill person Other household members should stay in another place of residence. If this is not possible, stay separated from the ill person as much as possible and use separate utilities and household items Who do not have an essential need to be at home Elderly people and people with medical conditions should stay away from the ill person Make sure that shared spaces at home have good air flow, such as air conditioning and open windows Wear appropriate PPE when in contact with the ill person’s body fluids. Dispose all PPE’s and contaminated items appropriately Clean all “high-touch” surfaces (counters, tabletops, toilets, etc.) while wearing appropriate PPE daily Stay Separated Restrict Visitors Elderly People and Medical Conditions Ventilation PPE Surfaces Laundry and Household Items Wash laundry and household items thoroughly and use detergents Wash Your Hands Wash your hands immediately after removing your medical mask, gown, gloves and at all times SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014
Doc ID 30 MoH Training Manual – v1.6 20140901 9. ENSURE SAFE COLLECTION AND HANDLING OF LAB SAMPLES MERS-CoV testing practices and lab procedures should follow strict PPE Responsibilities ▪ Swabbing should be done based on MERS-CoV case definition ▪ Swabbing personnel1 should be properly trained on the technique and wear PPE appropriate for aerosol generating procedures ▪ Use well-ventilated2 (min 6-12 air changes/hour) separate room in line with aerosol generating procedures requirements ▪ Fill the test form completely ▪ Ensure that healthcare facility laboratories adhere to appropriate biosafety practices and transport requirements Swabbing3 Transport ▪ Personnel who transports specimens should be trained in safe handling practices and spill decontamination ▪ Use leak-proof plastic biohazard specimen bags that have a separate sealable pocket for the specimen ▪ Maintain the temperature requirement (+4 degrees Celsius) for keeping the sample valid from collection till processing ▪ Notify the lab that the specimen is being transported All samples should be sent for testing to one of the 5 regional MoH labs4 unless otherwise specified (e.g., unless your hospital lab has acknowledged capabilities to run the PCR test for MERS-CoV) 1 Physicians or nurses, based on the hospital policy 2 When resources permit, negative pressure 3 Video on how to take nasopharyngeal swab: https://www.youtube.com/watch?v=hXohAo1d6tk 4 Jeddah, Riyadh, Dammam, Makkah, Medina SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
Doc ID 31 MoH Training Manual – v1.6 20140901 10. TAKE PRECAUTIONS IN THE MORTUARY Ensure adequate level of PPE in the morgue and follow strict visitor policy Deceased bodies pose a potential MERS-CoV infection risk General requirements  Body should be placed in impervious appropriately sized plastic body bag  Body washing must be done at the hospital morgue  If the family members wish to perform the body washing, they must adhere to the same precautions as body washers  Inform the family members about the risks associated with removing the body from the body bag Morgue staff PPE  Hand hygiene  Gloves  N95 respirator  Impermeable/water resistant protective gown  Boots/shoe covers  Eye protection (if the body needs to be embalmed) More information: GCC Infection Control Manual GCC-ICM-VIII-10 SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
Doc ID 32 MoH Training Manual – v1.6 20140901 Relevant videos How to properly do hand hygiene? http://www.youtube.com/watch?v=uGmMDC-4IMY Disclaimer: Refer to WHO standards of hand hygiene for more information How to put on personal protective equipment (PPE)? http://www.youtube.com/watch?v=HIR88sJEI2s Disclaimer: Refer to the KSA MERS-CoV Infection Control Guidelines for exact protective equipment required while caring for suspected/confirmed MERS-CoV patients How to take off personal protective equipment (PPE)? http://www.youtube.com/watch?v=vYMWTWE4xqU Disclaimer: Refer to the KSA MERS-CoV Infection Control Guidelines for exact protective equipment required while caring for suspected/confirmed MERS-CoV patients How to wear the N95 mask? http://www.youtube.com/watch?v=bo-PEzHE7iw Disclaimer: There might be differences in mask design for different brands How to fit test the N95 mask? https://www.youtube.com/watch?v=7IAsoU6h-8g Disclaimer: There might be differences in mask design for different brands How to take nasopharyngeal swab for MERS-CoV? https://www.youtube.com/watch?v=hXohAo1d6tk Disclaimer: Healthcare worker swabbing the patients, needs to comply to PPE requirements of aerosol generating procedures as per the KSA MERS-CoV Infection Control Guidelines
Doc ID 33 MoH Training Manual – v1.6 20140901 More information sources KSA MoH website about MERS-CoV http://www.moh.gov.sa/en/CoronaNew KSA General Directorate for Infection Prevention and Control http://www.gdipc.org/ GCC Infection Prevention and Control Manual http://www.gdipc.org/ic-manual.html CDC on MERS-CoV http://www.cdc.gov/CORONAVIRUS/MERS/INDEX.HTML WHO on MERS-CoV http://www.who.int/csr/disease/coronavirus_infections/en/ KSA MoH call center 8002494444 or 937 (toll free) E-mail suggestions about this presentation to corona@mohfeedback.com

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MERS CoV Prevention

  • 1.
    MERS-CoV infection control Classroom session-Clinical MoH Training Manual – v1.6 20140901
  • 2.
    Doc ID 1 MoH Training Manual – v1.6 20140901 We are here to stop the spread of MERS-CoV by fixing infection prevention and control in Saudi hospitals ▪ No vaccine ▪ No treatment ▪ High death rate ▪ Highly contagious in a hospital setting ▪ Hospital staff at high risk if not following infection control rules Strict infection control is the only way to stop MERS-CoV from spreading – everyone of us is responsible and can help to stop the disease
  • 3.
    Doc ID 2 MoH Training Manual – v1.6 20140901 Your 10 steps to fight MERS-CoV in your hospital 1. Maintain strict personal hygiene 2. Ensure proper use of PPE by staff and patient 3. Identify and isolate potential MERS-CoV patients early 4. Allocate adequate facilities for MERS-CoV patients 5. Follow appropriate housekeeping practices 6. Monitor staff health – don’t allow sick people at work 7. Implement stricter visitor policy 8. Send for home isolation under supervision, when possible 9. Ensure safe collection and handling of lab samples 10. Take precautions in the mortuary
  • 4.
    Doc ID 3 MoH Training Manual – v1.6 20140901 1. MAINTAIN STRICT PERSONAL HYGIENE You already know this, you just need to DO IT EVERY DAY Cough etiquette Short nails, no watches, no jewelry Other basics 11 10 2 FRI 16 ▪ Avoid touching your face ▪ Avoid touching patient’s items ▪ Do not share personal items ▪ Shower after work ▪ Change uniform daily ▪ Keep home clean and ventilated ▪ If you feel sick, do not come to work – tell your senior over phone ▪ Avoid contact with sick colleagues SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; the Infection Control powerpoint 12 6 9 3 1 4 5 7 8 TIMEZ INDIGLO WR30M 
  • 5.
    Doc ID 4 MoH Training Manual – v1.6 20140901 More on hand hygiene When to do it?  5 moments of hand hygiene  When hands are visibly soiled  After contact with a source of microorganisms (body fluids and substances, mucous membranes, non-intact skin, surfaces that are likely to be contaminated)  After removing gloves and before wearing them.  Before and after smoking, eating or preparing food  Before leaving the patient’s room  After bodily functions (e.g., using the toilet, blowing one’s nose, sneezing)  When moving from a contaminated body site to a clean body site during patient care SOURCE: WHO; Saudi Aramco John Hopkins How to do it? Use proper hand hygiene technique to disinfect all parts of your hands 1. MAINTAIN STRICT PERSONAL HYGIENE
  • 6.
    Doc ID 5 MoH Training Manual – v1.6 20140901 1. MAINTAIN STRICT PERSONAL HYGIENE Correct technique – how to handrub and handwash (1/3) Alcohol-based handrub is more efficient than handwash when hands are not soiled SOURCE: WHO; Saudi Aramco John Hopkins
  • 7.
    Doc ID 6 MoH Training Manual – v1.6 20140901 1. MAINTAIN STRICT PERSONAL HYGIENE SOURCE: WHO
  • 8.
    Doc ID 7 MoH Training Manual – v1.6 20140901 Hand washing Technique
  • 9.
    Doc ID 8 MoH Training Manual – v1.6 20140901 2. ENSURE PROPER USE OF PPE BY STAFF AND PATIENTS Droplet and contact precautions required when dealing with potential MERS-CoV patients; N95 to be worn during aerosol generating procedures Potential/confirmed MERS-CoV: in patient’s room/close contact – contact and droplet precautions (for healthcare workers and visitors) ▪ Surgical mask (N95 for aerosol generating procedures) ▪ Eye protection (goggles/face shield) ▪ Gown (clean, non-sterile, long-sleeved) ▪ Gloves (some procedure may require sterile gloves) ▪ Impermeable apron (for procedures with expected splashes) May be considered if resources permit: ▪ Airborne precautions with all potential/confirmed MERS-CoV patients (N95) ▪ Surgical mask for all fever/respiratory patients at the ER entrance Safely remove PPE and perform hand hygiene when leaving the MERS-CoV precautions area (e.g., isolation or procedure room) SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; CDC pictures
  • 10.
    Doc ID MoHTraining Manual – v1.6 20140901 9 2. ENSURE PROPER USE OF PPE BY STAFF AND PATIENTS N95 provides protection only if appropriately used Do not use N95 with valves  …When working in a sterile field such as an operating room Conduct fit test for your N95  N-95 mask comes in different sizes and offers no protection if not properly fitted  Fit test has to be performed for employees wearing N95 to ensure proper fit How to fit test N95 mask: https://www.youtube.com/watch?v=7IAsoU6h-8g Never wear a medical mask under the N95 mask as this prevents proper fitting and sealing of the N95 mask thus decreasing its efficacy. Source: Saudi Aramco Johns Hopkins Inspect your N95 every time before wearing ▪ For structural integrity ▪ Ensure that the straps are not cut or damaged ▪ Make sure the metal nose clip is in place and functions properly ▪ Determine if it is physically damaged or soiled How to wear N95 mask: http://www.youtube.com/watch?v=bo-PEzHE7iw
  • 11.
    Doc ID 10 Extended Use of N95 Filtering, face piece, respirators in healthcare settings: Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several patients, without removing the respirator between patient encounters. Extended use may be implemented when multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards. * Discard N95 respirators following use during aerosol generating procedures. * Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients. * Perform hand hygiene with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).
  • 12.
    Doc ID 11 Reuse of N95 filtering, face piece, respirators in Health care settings Reuse refers to the practice of using the same N95 respirator for multiple encounters with patients but removing it (“doffing”) after each encounter. The respirator is stored in between encounters to be put on again (“donned”) prior to the next encounter with a patient. • Discard N95 respirators following use during aerosol generating procedures. • Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients. *Store respirators in a single disposable paper container with identification. •Clean hands with soap and water or an alcohol-based sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).
  • 13.
    Doc ID 12 Reuse continued: •Clean hands with soap and water or an alcohol-based sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit). Clean hands with soap and water or an alcohol-based sanitizer after donning a used N95 respirator and performing a user seal check. • Follow the manufacturer’s user instructions, including conducting a user seal check. • Maximum number of donning up to five times if the manufacturer does not provide a recommendation. • Discard any respirator that is obviously damaged or becomes hard to breathe through. *Pack or store respirators between uses so that they do not become damaged or deformed.
  • 14.
    Doc ID MoHTraining Manual – v1.6 20140901 13 Veil and beard with the N95 mask VEIL For female staff who wear veils, the medical or N95 mask should always be placed directly on the face behind the veil and not over the veil. In this instance a face shield should also be used along with the mask. BEARD N95 does not provide full protection for people with beards – use alternative respirator such as powered air purifying respirator, should be used.
  • 15.
    MoH Training Manual– v1.6 20140901 SEQUENCE FOR DONNING PERSONAL PROTECTIVE EQUIPMENT ( PPE ) The type of PPE used will vary based on the level of precautions required: e.g., Standard and Contact, Droplet or Airborne Infection Isolation. 1. GOWN • Fully cover torso from neck to knees, arms to end of wrists • , and wrap around the back • Fasten in back of neck and waist 2. MASK OR RESPIRATOR • Secure ties or elastic bands at middle of head and neck • Fit flexible band to nose bridge • Fit snug to face and below chin • Fit-check respirator 3. GOGGLES OR FACE SHIELD • Place over face and eyes and adjust to fit 4. GLOVES • Extend to cover wrist of isolation gown USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION ■ Keep hands away from face ■ Limit surfaces touched ■ Change gloves when torn or heavily contaminated ■ Perform hand hygiene Putting on PPE: http://www.youtube.com/watch?v=HIR88sJEI2s SOURCE: CDC (http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf)
  • 16.
    MoH Training Manual– v1.6 20140901 SEQUENCE FOR DOFFING ( removing ) PERSONAL PROTECTIVE EQUIPMENT ( PPE ) Except for respirator, remove PPE at doorway or inside the patient’s room. Remove respirator after leaving patient room and closing door (anteroom). 1. GLOVES • Outside of gloves is contaminated! • Grasp outside of glove with opposite gloved hand; peel off • Hold removed glove in gloved hand • Slide fingers of ungloved hand under remaining glove at wrist • Peel glove off over first glove • Discard gloves in waste container *Perform Hand Hygiene* WHO STATES HAND HYGIENE BEFORE PUTTING ON GLOVES AND IMMEDIATELY AFTER REMOVING GLOVES 2. GOGGLES OR FACE SHIELD • Outside of goggles or face shield is contaminated! • To remove, handle by head band or ear pieces • Place in designated receptacle for reprocessing or in waste container 3. GOWN • Gown front and sleeves are contaminated! • Unfasten ties • Pull away from neck and shoulders, touching • inside of gown only • Turn gown inside out • Fold or roll into a bundle and discard *Perform Hand Hygiene* 4. MASK OR RESPIRATOR ( done outside of the room ) • Front of mask/respirator is contaminated — • DO NOT TOUCH! • Grasp bottom, then top ties or elastics and remove • Discard in waste container HAND HYGIENE COULD BE PERFORMED AFTER EVERY STEP OF REMOVAL OF SUSPECTED CONTAMINATED PPE SOURCE: CDC (http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf) Taking off PPE: http://www.youtube.com/watch?v=vYMWTWE4xqU
  • 17.
    Doc ID 16 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Promptly identify symptomatic patients at the hospital entry and take MERS-CoV precautions until recovery, regardless of test results Patients with fever, ARI1, diarrhea and other Take precautions for MERS-CoV ▪ PPE for staff and source control for patient ▪ Isolation2 Test for other pathogens. If patient meets MERS-CoV case definition, also test for MERS-CoV MERS-CoV positive MERS-CoV negative3 Take precautions for MERS-CoV until symptoms resolve ▪ PPE for staff and source control for patient ▪ Isolation2 1 Acute respiratory infections – symptoms including runny nose, sneezing, coughing, shortness of breath 2 In hospital or home 3 And no alternative confirmed diagnosis / still suspicion for MERS – for multiple reasons, negative tests do not fully rule out possibility of MERS-CoV SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014 When possible ▪ Identify symptomatic patients at the hospital entrance ▪ Allocate a separate room/area in ER for symptomatic patients ▪ Allocate separate procedure rooms for symptomatic patients ▪ Restrict visitors and do not rotate personnel in high risk MERS-CoV area
  • 18.
    Doc ID 17 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS MERS-CoV case definition has to be followed when testing for MERS-CoV Suspect case (patients who should be tested for MERS-CoV) I. A person with fever and community-acquired pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence OR II. A hospitalized patient with healthcare associated pneumonia based on clinical and radiological evidence OR III. A person with 1) Acute febrile (≥38°C) illness AND 2) Body aches, headache, diarrhea, or nausea/ vomiting, with or without respiratory symptoms AND 3) Unexplained leucopenia (WBC<3.5x10/L) and thrombocytopenia (platelets<150x10/L) OR IV. A person (including health care workers) who had protected or unprotected exposure to a confirmed or probable case of MERS-CoV infection and who presents with upper or lower respiratory illness within 2 weeks after exposure ▪ A probable case is a patient in category I or II with absent or inconclusive laboratory results for MERS-CoV and other possible pathogens who is a close contact of a laboratory-confirmed MERS-CoV case or who works in a hospital where MERS-CoV cases are cared for ▪ A confirmed case is a person with laboratory confirmation of MERS-CoV infection SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
  • 19.
    Doc ID 18 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Triage and screening for MERS-CoV PATIENTS COMING TO THE EMERGENCY ROOM SCREENING FOR MERS SYMPTOMS There should be a separate desk or room outside the ER patient care area, where new patients are screened. Posters for patient to self-triage must be visible here. Visitors must be strictly controlled. The doctor & nurse here should wear surgical masks or N95 and follow general precautions. Send patient to the regular ER triage and waiting area. 1. Put regular mask on patient 2. Shift to isolation room / area 3. Give emergency treatment 4. Test for MERS-CoV 5. Based on clinical assessment, Admit to MERS unit or send home with advice on hand washing, cough etiquette & home isolation MERS SYMPTOMS NO SYMPTOMS Follow MERS case definition criteria to identify cases MERS MANAGEMENT
  • 20.
    Doc ID 19 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Decision 1 – Is it an ARI patient (potential MERS)? YES Patient ER reception ▪ Apply standard precautions ▪ Provide the patient with a medical mask ▪ Lead the patient into designated waiting area for ARI patients NO Patient ER reception ▪ Apply standard precautions ▪ Lead the patient into general ER waiting area Do you have any of these: I feel sick. Help me! Patient ER reception Practical tips ▪ Allocate a separate isolated area for ARI patients in your ER ▪ Ensure ER receptionist wears PPE (mask) and performs hand hygiene ▪ Ensure everybody in ARI part of ER wears PPE (masks) and performs hand hygiene ▪ Have signage and displays for patients, provide masks SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014
  • 21.
    Doc ID 20 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Decision 2 – Should we test for MERS? Patient CASE DEFINITION CONFIRMED NO CASE DEFINITION Physician SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014 ▪ Take nasopharyngeal swab for MERS-CoV test ▪ Place patient into isolated single room ▪ Treat the patient based on his/her healthcare needs ▪ Keep applying basic precautions (PPE etc.)  Acquire clinical or radiological evidence necessary to confirm MERS case definition Practical tips ▪ All radiological procedure should be done on site as long as possible
  • 22.
    Doc ID 21 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Decision 3 – Isolate in the hospital or at home? Test results Physician  Take decision about further patient treatment based on test results, pre-sence of symptoms and patient’s living conditions MERS POSITIVE SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014 ▪ Continue hospital isolation if – Patient has MERS symptoms ▪ Isolate at home1 if – Patient has no MERS symptoms MERS NEGATIVE ▪ Continue hospital isolation if – CD I or II, or – CD III or IV with pneumonia ▪ Isolate at home1 if – CD III or IV without pneumonia 1 Home should be suitable for isolation based on Home Isolation Guidelines – if not suitable, keep in isolation in the hospital
  • 23.
    Doc ID 22 MoH Training Manual – v1.6 20140901 3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS Decision 4 – When to discharge the patient? Hospital isolation Home isolation Patient discharge criteria ▪ Patient is clinically well for 24 hours, and – No clinical concern for viral shedding, or – Repeated MERS CoV test is negative ▪ Repeated weekly test is negative SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014
  • 24.
    Doc ID 23 4. ALLOCATE ADEQUATE FACILITIES FOR MERS-CoV PATIENTS1 Place patient in isolation – Patient placement requirement ▪ Place patients with suspected, probable or confirmed MERS-CoV infection who are not critically ill in adequately ventilated single room. ▪ Place patients with suspected, probable or confirmed MERS-CoV infection who are critically ill in a negative pressure room. If not available then single room with HEPA filter. ▪ The rooms used for isolation should be situated in an area that is clearly segregated from other patient-care areas ▪ When single rooms are not available, cohort – put patients with the same lab confirmed diagnosis together (i.e., taking into consideration positive MERS-CoV and other contagious diseases ) ▪ Use HEPA-filters when negative pressure rooms not available ▪ Standard, contact & droplet precautions should be used for all suspected and confirmed patients. ▪ When an AGP is being anticipated air borne precautions should be added MERS-CoV More information: GCC Infection Control Manual GCC-ICM-III-03, 04, 05 1 Both, potential and confirmed SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
  • 25.
    Doc ID 24 MoH Training Manual – v1.6 20140901 5. FOLLOW APPROPRIATE HOUSEKEEPING PRACTICES Housekeeping standards and rules should be followed Item sharing Requirements ▪ Use disposable or dedicated equipment when possible ▪ Clean and disinfect shared equipment between patients ▪ Discard single-use devices in a hands-free waste bin House-keeping standards ▪ Comply with the hospital’s standards and GCC Infection Control Manual on all procedures (cleaning, waste etc.) ▪ Follow PPE requirements for MERS-CoV or higher ▪ Use hospital approved disinfectants with approved dilution Areas ▪ Clean all horizontal and frequently touched surfaces (incl. medical equipment) at least twice daily/once a shift ▪ Clean isolation areas last; when possible, change mop head after each isolation room, disinfect after each use ▪ Follow hospital’s terminal cleaning protocol for patient’s room when vacated by the previous patient. Replace curtains when terminal cleaning. SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
  • 26.
    Doc ID 25 MoH Training Manual – v1.6 20140901 6. MONITOR STAFF HEALTH – DON’T ALLOW SICK PEOPLE AT WORK Monitor staff health – identify and exclude symptomatic staff from work Recommendations Healthcare facility ▪ Implement flexible non-punitive sick leave policies for staff ▪ Provide staff with quick access to medical consultation and treatment ▪ Screen all staff for MERS-CoV symptoms at the beginning of the shift ▪ Exclude symptomatic staff from work ▪ Dedicate the same staff to MERS-CoV patients ▪ Track staff exposure to MERS-CoV patients ▪ If resources permit, provide separate accommodation for staff with regular exposure to potential/confirmed MERS-CoV patients Staff ▪ In general: – Monitor MERS-CoV symptoms – Report to supervisor if symptomatic ▪ If symptomatic – Do not come to work/stop working immediately – Notify supervisor – Wear surgical mask for source control – Seek prompt medical evaluation – Stay on leave until no longer infectious ▪ If asymptomatic but had unprotected close MERS-CoV exposure – Monitor symptoms – Wear surgical mask for source control (when not wearing N95) – Consider exclusion from work until found non-infectious SOURCE: CDC MERS-CoV recommendations
  • 27.
    Doc ID 26 MoH Training Manual – v1.6 20140901 7. IMPLEMENT STRICTER VISITOR POLICY Limit the number of visitors and train them to comply with precautions Visitor management requirement ▪ Limit the number of visitors and family members to those essential for patient support Additional practices if resources permit ▪ Screen visitors for ARI symptoms at the hospital entrance ▪ Evaluate risk to visitors’ health (e.g., due to underlying illness) and ability to comply with precautions ▪ Instruct visitors on hand hygiene, potentially contaminated surfaces, and use of PPE, before entry into the patient care area and supply necessary equipment (e.g., surgical masks) ▪ Track (e.g., via logbook) all visitors to MERS-CoV patient rooms ▪ Allow no visitors during aerosol-generating procedures (and if possible, for one hour after) ▪ Limit visitor movement within the facility (e.g., visitors to MERS-CoV patient rooms should not visit other areas). A security personnel should be assigned outside any unit with suspected or confirmed cases to limit access to isolated patients. 1 Acute respiratory infections SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; CDC MERS-CoV recommendations
  • 28.
    Doc ID 27 MoH Training Manual – v1.6 20140901 8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE Patients with no shortness of breath, hypoxemia or pneumonia can be isolated at home, provided home facilities meet the requirements Assess (by phone or direct observation) whether the home is appropriate for isolating the ill person  The home should have a functioning bathroom – ideally, one bathroom should be designated solely for the ill person  The ill person should have his or her own bed and preferably a private room for sleeping  Basic amenities, such as AC, electricity, potable and hot water, sewer, and telephone access, should be available  There should be a primary caregiver who can - Follow doctor’s instructions for medications and care - Help the ill person with basic needs Follow MERS-CoV Home Isolation Guidelines for patient home care requirements SOURCE: KSA MoH MERS-CoV Home Isolation Guidelines, May 2014
  • 29.
    Doc ID 28 MoH Training Manual – v1.6 20140901 8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE Home isolated patient needs to follow Separate oneself from other people in the house Call ahead before visiting doctor Wear a medical mask Patient must… Cover coughs and sneezes Avoid sharing household items Wash hands SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014
  • 30.
    Doc ID 29 MoH Training Manual – v1.6 20140901 8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE Family and caregivers have to take precautions Health Care Providers Instructions Limit the number of people at home Be aware of them and help the ill person follow them To only essential for providing care for the ill person Other household members should stay in another place of residence. If this is not possible, stay separated from the ill person as much as possible and use separate utilities and household items Who do not have an essential need to be at home Elderly people and people with medical conditions should stay away from the ill person Make sure that shared spaces at home have good air flow, such as air conditioning and open windows Wear appropriate PPE when in contact with the ill person’s body fluids. Dispose all PPE’s and contaminated items appropriately Clean all “high-touch” surfaces (counters, tabletops, toilets, etc.) while wearing appropriate PPE daily Stay Separated Restrict Visitors Elderly People and Medical Conditions Ventilation PPE Surfaces Laundry and Household Items Wash laundry and household items thoroughly and use detergents Wash Your Hands Wash your hands immediately after removing your medical mask, gown, gloves and at all times SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014
  • 31.
    Doc ID 30 MoH Training Manual – v1.6 20140901 9. ENSURE SAFE COLLECTION AND HANDLING OF LAB SAMPLES MERS-CoV testing practices and lab procedures should follow strict PPE Responsibilities ▪ Swabbing should be done based on MERS-CoV case definition ▪ Swabbing personnel1 should be properly trained on the technique and wear PPE appropriate for aerosol generating procedures ▪ Use well-ventilated2 (min 6-12 air changes/hour) separate room in line with aerosol generating procedures requirements ▪ Fill the test form completely ▪ Ensure that healthcare facility laboratories adhere to appropriate biosafety practices and transport requirements Swabbing3 Transport ▪ Personnel who transports specimens should be trained in safe handling practices and spill decontamination ▪ Use leak-proof plastic biohazard specimen bags that have a separate sealable pocket for the specimen ▪ Maintain the temperature requirement (+4 degrees Celsius) for keeping the sample valid from collection till processing ▪ Notify the lab that the specimen is being transported All samples should be sent for testing to one of the 5 regional MoH labs4 unless otherwise specified (e.g., unless your hospital lab has acknowledged capabilities to run the PCR test for MERS-CoV) 1 Physicians or nurses, based on the hospital policy 2 When resources permit, negative pressure 3 Video on how to take nasopharyngeal swab: https://www.youtube.com/watch?v=hXohAo1d6tk 4 Jeddah, Riyadh, Dammam, Makkah, Medina SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
  • 32.
    Doc ID 31 MoH Training Manual – v1.6 20140901 10. TAKE PRECAUTIONS IN THE MORTUARY Ensure adequate level of PPE in the morgue and follow strict visitor policy Deceased bodies pose a potential MERS-CoV infection risk General requirements  Body should be placed in impervious appropriately sized plastic body bag  Body washing must be done at the hospital morgue  If the family members wish to perform the body washing, they must adhere to the same precautions as body washers  Inform the family members about the risks associated with removing the body from the body bag Morgue staff PPE  Hand hygiene  Gloves  N95 respirator  Impermeable/water resistant protective gown  Boots/shoe covers  Eye protection (if the body needs to be embalmed) More information: GCC Infection Control Manual GCC-ICM-VIII-10 SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014
  • 33.
    Doc ID 32 MoH Training Manual – v1.6 20140901 Relevant videos How to properly do hand hygiene? http://www.youtube.com/watch?v=uGmMDC-4IMY Disclaimer: Refer to WHO standards of hand hygiene for more information How to put on personal protective equipment (PPE)? http://www.youtube.com/watch?v=HIR88sJEI2s Disclaimer: Refer to the KSA MERS-CoV Infection Control Guidelines for exact protective equipment required while caring for suspected/confirmed MERS-CoV patients How to take off personal protective equipment (PPE)? http://www.youtube.com/watch?v=vYMWTWE4xqU Disclaimer: Refer to the KSA MERS-CoV Infection Control Guidelines for exact protective equipment required while caring for suspected/confirmed MERS-CoV patients How to wear the N95 mask? http://www.youtube.com/watch?v=bo-PEzHE7iw Disclaimer: There might be differences in mask design for different brands How to fit test the N95 mask? https://www.youtube.com/watch?v=7IAsoU6h-8g Disclaimer: There might be differences in mask design for different brands How to take nasopharyngeal swab for MERS-CoV? https://www.youtube.com/watch?v=hXohAo1d6tk Disclaimer: Healthcare worker swabbing the patients, needs to comply to PPE requirements of aerosol generating procedures as per the KSA MERS-CoV Infection Control Guidelines
  • 34.
    Doc ID 33 MoH Training Manual – v1.6 20140901 More information sources KSA MoH website about MERS-CoV http://www.moh.gov.sa/en/CoronaNew KSA General Directorate for Infection Prevention and Control http://www.gdipc.org/ GCC Infection Prevention and Control Manual http://www.gdipc.org/ic-manual.html CDC on MERS-CoV http://www.cdc.gov/CORONAVIRUS/MERS/INDEX.HTML WHO on MERS-CoV http://www.who.int/csr/disease/coronavirus_infections/en/ KSA MoH call center 8002494444 or 937 (toll free) E-mail suggestions about this presentation to corona@mohfeedback.com

Editor's Notes

  • #15 Lecturer Should Elaborate that disposable “ Hijab “ ( Veil ) and beard covers are coming to the hospitals.
  • #20 Elaborate on Surgical mask for doctors and nurses as the 1st option
  • #33 Reminder slide for advanced PPE