Infection control is a major culprit in the often-fatal virus known as Middle East respiratory syndrome coronavirus (MERS-CoV), according to a review published in the December issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).
Researchers from the Hellenic Center for Disease Control and Prevention in Athens, Greece, reviewed 252 papers on MERS-CoV, ultimately narrowing their focus to 10 studies covering 11 cases of possible or confirmed healthcare-associated transmission of the virus. Although the majority of cases have occurred in Middle Eastern countries since the virus first appeared in 2012, documented cases also have appeared in the United States, Europe and Africa.
Healthcare workers, particularly nurses, are at heightened risk of acquiring MERS-CoV from infected people, from the environment or through person-to-person contact. The virus can survive for at least 48 hours on healthcare facility surfaces and can be transmitted through vomit and diarrhea, which occur in about one-third of cases. MERS-CoV has been detected for up to 16 days in respiratory specimens and stool and up to 13 days in urine.
The review authors recommend caring for those with confirmed or suspected MERS-CoV infection under contact and droplet precautions. World Health Organization (WHO) guidelines call for wearing a high-protection mask (that is, N95 respirator), eye goggles, gowns and gloves during aerosol-generating procedures. The U.S. Centers for Disease Control and Prevention recommends use of respirator masks when in contact with any MERS-CoV patient (suspected or confirmed).
Although the WHO has identified infection control gaps within healthcare facilities as the reason behind the outbreaks, the writers say that further research is needed to confirm whether the gaps concern the use of personal protective equipment, hand hygiene, procedures, environmental cleaning or triage.