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Volume 23, Number 6—June 2017


Hospital Outbreaks of Middle East Respiratory Syndrome, Daejeon, South Korea, 2015

Jung Wan Park, Keon Joo Lee, Kang Hyoung Lee, Sang Hyup Lee, Jung Rae Cho, Jin Won Mo, Soo Young Choi, Geun Yong Kwon, Ji-Yeon Shin, Jee Young Hong, Jin Kim, Mi-Yeon Yeon, Jong Seok Oh, and Hae-Sung NamComments to Author 
Author affiliations: Korea Centers for Disease Control and Prevention, Cheongju, South Korea (J.W. Park, K.J. Lee); Sokcho Medical Center, Sokcho, South Korea (K.H. Lee); Ulsan Metropolitan City Hall, Ulsan, South Korea (S.H. Lee); Daejeon Provincial Government, Daejeon, South Korea (J.R. Cho); Chuncheongbukdo Provincial Government, Cheongju (J.W. Mo); DaeChung Hospital, Daejeon (S.Y. Choi); Ministry of Health and Welfare, Sejong, South Korea (G.Y. Kwon); Eulji University School of Medicine, Daejeon (J.-Y. Shin); Konyang University College of Medicine, Daejeon (J.Y. Hong); Chungnam National University School of Medicine, Daejeon (J. Kim, M.-Y. Yeon, H.-S. Nam); Gwanggyo Ean Pediatric Clinic, Suwon, South Korea (J.S. Oh)

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Table 1

Quarantine policy to prevent additional transmission of MERS, Daejeon, South Korea*

• The cohort quarantine applied to admitted patients and their caregivers (professional or family) exposed to the MERS case-patients.
• Inpatients admitted to the same hospital room before quarantine were quarantined in the same room because their degree of exposure was probably the same. Their caregivers were also quarantined in the same room because of the need for caregiving.
• The medical staff (physicians, nurses, and medical technologists) exposed to the MERS case-patients were subjected to home quarantine. However, members of the households of medical staff were not subjected to home quarantine until and unless that medical staff member exhibited any symptoms. Contact between household members and the medical staff member was severely restricted.
• The wards under cohort quarantine were controlled by unexposed medical staff using level D protectors (Microguard 2000; 3M, Bracknell, UK). Each protector included an N95 mask, protective glasses, a whole-body protective gown, gloves, and boots.
• The body temperature of persons (including inpatients and caregivers) and medical staff admitted to cohort or home quarantine was checked, and these persons were clinically interviewed twice daily. If they reported any symptoms (including a febrile sensation or chills) or if they were asymptomatic but with a body temperature >37.5C°, they were immediately placed in a quarantined area at each hospital. The KCDC performed laboratory tests at this stage; the results were available 3 d later. If the doctor in charge strongly suspected MERS, that patient could be transferred, with careful precautions, to a national isolation hospital within 1 d.
• All wards were disinfected by use of sodium hydrosulfite, 80% (vol/vol) alcohol, and 2% (vol/vol) chlorhexidine twice during each shift, thus 6 times/d.
• South Korea operates a nationwide medical insurance scheme; all costs incurred by MERS patients were covered.
• Persons with confirmed MERS were transferred to another quarantine room that had negative-pressure equipment.
Strategies for caregivers
• The infection control team carefully explained the risk for MERS and the need for cohort quarantine to all caregivers. Some caregivers did not wish to remain in hospital wards with inpatients. They were taken home and placed in in-home quarantine and used the same MERS quarantine strategy applicable to medical staff in close contact with the patients.
• Caregivers attended only noninfected inpatients who required total care. If an inpatient was confirmed to have MERS, nursing care was provided by professional nurses wearing protectors.
• The infection control team continuously educated caregivers on how MERS was transmitted and how to prevent infection. Caregivers were told to wear protectors (N95 masks, vinyl gowns, and gloves) and to not touch each other. However, during the first week of quarantine, checks of closed-circuit television footage showed that the protector and contact rules were sometimes not obeyed in hospital A.
• Hospital A designated 2 rooms for caregivers in the quarantine ward. The caregivers could use these rooms when they were not actively engaged in patient care.

*KCDC, Korea Centers for Disease Control and Prevention; MERS, Middle East respiratory syndrome.

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