Statement on Advice to Health Care Workers caring for patients with confirmed or possible MERS-CoV infection, 14 June 2013 (EC/EWRS, April 29 2014)

[Giuseppe]

[Source: European Commission, full PDF document: (LINK). Edited.]


Draft Health Security Committee/ Early Warning and Response System

Statement on Advice to Health Care Workers caring for patients with confirmed or possible MERS-CoV infection, 14 June 2013


As of 12 June 2013, all Middle East Respiratory Syndrome Coronavirus (MERS-CoV) cases remain associated with transmission in the Middle East.

Information on the reservoir and mode of transmission in the affected area remains virtually absent, but there is strong evidence of limited human-to-human transmission and health-care associated transmission having occurred in the EU, in Jordan and in the Arabian Peninsula.

It is expected that small numbers of cases will continue to present to health care services in the EU as a result of:

• medical transfers of MERS-CoV infected patients into the EU for specialist care;
• patients who acquired the infection while visiting the affected area and present in the EU; and
• patients who are exposed to and infected with MERS-CoV through contacts with confirmed cases in the EU (secondary transmission in the EU).

Advice on infection control

This is a summary of the recommended technical measures for reducing the risk of transmission of MERS-CoV in health care settings and laboratories in the EU for consideration by national contact points.

It draws on interim advice produced by WHO and others, but in certain cases considers additional precautions to deal with the uncertainty that currently persists regarding the exact risk of transmission of this virus.

The highest risk of health care associated transmission is in the absence of standard precautions, when basic infection prevention and control measures for respiratory infections are not in place, and before MERS-CoV infection has been confirmed.

The summary of the advice follows:

• Standard precautions (hand hygiene and use of personal protective equipment (PPE) to avoid direct contact with patients? blood, non-intact skin, body fluids and secretions, including respiratory secretions) should be applied for all patients.
• Persons who have within the last 14 days visited the areas mentioned above ? or who have been in contact with such a person within the last 14 days ? and who present to health care with acute respiratory infections (ARI) should be separated from other patients in waiting areas and in-patient settings. These persons, and all individuals in contact with them, including visitors and health care workers, should wear a disposable surgical or medical procedure mask.
• Health care providers should actively and rapidly establish if a patient presenting with ARI meets the case finding definitions for MERS-CoV and proceed with diagnostic procedures and infection control measures accordingly.
• Possible and confirmed cases requiring admission should be admitted directly to negative-pressure single rooms, if available. If this is not possible then a single room with en-suite facilities should be used. Positive pressure rooms should not be used.
• Health care personnel providing care for persons requiring investigation (PRIs) for MERS-CoV and confirmed cases should:
  • Use personal protective equipment for droplet transmission of pathogens (well-fitted FFP2 or FFP3 respirator, gown, gloves);
  • Self-monitor for symptoms.
  
  
• The WHO interim guidance on infection prevention and control during health care for probable or confirmed cases of novel coronavirus (nCoV) infection (6 May 2013) should be consulted for more detailed guidance on other aspects of infection control. Available from: http://www.who.int/csr/disease/coronavirus_infections/IPCnCoVguidance_06May13.pdf
• A record of all staff caring for confirmed MERS-CoV cases must be maintained, and exposed health care workers should be vigilant for any respiratory symptoms in the 14 days following last exposure to a confirmed case and should seek testing and thereafter self-isolate if they become unwell.
• Medical procedures, particularly aerosol-generating procedures and all airway management, such a tracheal intubation, broncho-alveolar lavage, other diagnostic airway procedures and manual ventilation, require particular protection measures. The number of persons in the room should be limited to a minimum during such procedures and all present should wear:
  • A well-fitted FFP3 respirator
  • Tight-fitting eye protection
  • Gloves and long-sleeved impermeable protective gowns
  
  
• All specimens collected for laboratory investigation should be regarded as potentially infectious, and health care workers who collect or transport clinical specimens should adhere rigorously to Standard Precautions to minimize the possibility of exposure to pathogens. The WHO Aide-memoire on Standard Precautions in Health Care is available from: http://www.who.int/csr/resources/publications/EPR_AM2_E7.pdf
• Laboratories should adhere to guidance in these two documents:
  • The European Committee for Standardisation: CWA15793 Laboratory Biorisk Management, 2011, available from: http://www.cen.eu/CEN/sectors/technicalcommitteesworkshops/workshops/Pages/ws31.aspx, and
  • The World Health Organization: Novel Coronavirus: Interim Recommendations for Laboratory Biorisk Management of 19 February 2013, available from: http://www.who.int/csr/disease/coronavirus_infections/NovelCoronavirus_InterimRecommendationsLaboratoryB iorisk_190213/en/index.html
  
  
• The duration of infectivity for MERS-CoV patients remain unknown. Critically ill patients can shed virus for long periods and viral detection tests should assist the decision on when to discontinue additional precautions for hospitalised patients.

The Health Security Committee will re-evaluate the evidence and situation on a regular basis and revise this statement accordingly.


-
------