This article is more than 5 years old. Information may no longer be current.
Infection control may have stopped MERS spread in South Korea dialysis unit
Click Here to Manage Email Alerts
BOSTON — After implementing infection control measures, a hospital dialysis unit in South Korea observed no spread of Middle East respiratory syndrome, or MERS, after the illness was confirmed in one patient on hemodialysis.
The surveillance and isolation interventions were conducted in a dialysis unit in Seoul during the 2015 MERS outbreak in South Korea — the largest outside Saudi Arabia — which included 186 confirmed cases, including 36 deaths.
The index patient, a male aged 79 years on hemodialysis, developed a fever and was later tested for MERS out of an abundance of caution after reporting a cough and diarrhea, according to Soo-youn Moon, MD, of the division of infectious diseases, department of internal medicine, Kyung Hee University School of Medicine.
“He had no history of travel to the Middle East and no suspected contact with MERS, but during the outbreak so many people were tested for MERS infection because of the fear of spread,” Moon said during a presentation at ASM Microbe.
She said the unit was prompted to take precautions based on a study showing that MERS spread in a hemodialysis unit in Saudi Arabia in 2013.
Following the positive test, hand hygiene, surgical masks and body temperature monitoring were required for all patients entering the unit while Moon and colleagues began a cohort dialysis of between seven and eight patients per session for 2 weeks. They eliminated beds from the unit and moved the remaining beds farther apart so that they were separated by approximately 2.5 meters, isolating the patients.
Further, health care workers in the unit wore Level D personal protective equipment — waterproof disposable gowns, face shields or goggles, N95 respirators and gloves — and disinfected the environment after each hemodialysis session.
RT-PCR was performed at the beginning and end of isolation, and patients were observed for symptoms possibly related to MERS. Serum was tested after 2 and 4 weeks from possible exposure.
In all, 104 patients and 18 health care workers experienced possible exposure to MERS in the dialysis unit. Among the patients, 22.1% (n = 23) developed symptoms possibly related to MERS, including fever, cough and diarrhea. Two patients — females aged 87 and 90 years — died of aspiration pneumonia, but neither patient had MERS, Moon said.
Not every patient consented to testing, but the 84 who did were found to be negative for MERS at 2 and 4 weeks.
Moon acknowledged that there was no way to know for sure whether these interventions had prevented further spread of the disease, “but isolation and cohort dialysis might help prevent transmission” in a dialysis unit when one of the patients is confirmed to be infected, she said. – by Gerard Gallagher
References:
Assiri A, et al. N Engl J Med. 2013;doi:10.1056/NEJMoa1306742.
Moon S-y, et al. Middle East respiratory syndrome coronavirus transmission in dialysis patients and infection control interventions. Presented at: ASM Microbe; June 16-20, 2016; Boston.
Disclosure: Moon reports no relevant financial disclosures.