The Public Health Agency of Canada (the Agency) has developed this document to provide infection prevention and control (IPC) guidance to healthcare organizations and healthcare workers (HCWs) for the management of patients presenting to healthcare facilities in Canada, who have travelled from affected areasFootnote b within 14 days before onset of illness and are suspected or confirmed to have a MERS-CoV infection or who have had close contact with a confirmed or probable case of MERS-CoV infection, while the case was ill, within 14 days before onset of illness.
The content of this guidance has been informed by technical advice provided by members of the Agency’s Infection Prevention and Control Expert Working Group. This guidance is based on current, available scientific evidence and is subject to review and change as new information becomes available.
The following guidance should be read in conjunction with relevant provincial and territorial, and local legislation, regulations, and policies.
(Refer to Recommended IPC Measures section below for details)
The following guidance is based primarily on recommendations in the Agency’s Hand Hygiene Practices in Healthcare Settings guidelineFootnote 1, Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care guidelineFootnote 2, the Infection Prevention and Control Measures for Healthcare Workers in Acute Care and Long-term Care Settings guidance-Seasonal InfluenzaFootnote 3, Infection Control Guideline for the Prevention of Healthcare-associated Pneumonia guidelineFootnote 4, and the Canadian Pandemic Influenza Plan for the health sector - Annex F Footnote 5 ,along with the World Health Organization’s guidanceFootnote 6.
In addition to routine practices, patients suspected or confirmed to have MERS-CoV infection should be managed with Contact and Droplet Precautions, along with Airborne Precautions for aerosol generating medical procedures (AGMP).
A major role of all healthcare organizations is to minimize the risk of exposure to, and transmission of, microorganisms within healthcare settings. This can be achieved by having policies, procedures and programs based on the following engineering and administrative measures.
Patients suspected or confirmed to have MERS-CoV infection should be restricted to their room and from group activities until symptoms have resolved. Patient movement/transport should be restricted to essential diagnostic and therapeutic tests only. If patients need to leave their room, they should wear a mask, be instructed on respiratory hygiene, be instructed on, or assisted with, hand hygiene, and be provided with clean clothes.
Transfer within facilities should be avoided unless medically indicated. If a medically indicated transfer is necessary the following measures should be taken:
HCWs should use a point-of-care risk assessment approach (Appendix A) before each patient interaction to evaluate the likelihood of exposure.
Personal protective equipment (PPE) for contact and droplet precautions should be provided outside the room of the patient suspected or confirmed to have MERS-CoV infection. HCWs, families and visitors should use the following PPE:
Gloves should be worn upon entering the patient’s room (for care of the patient and for contact with the patient’s environment).
A long-sleeved gown should be worn upon entering the patient’s room.
Facial protection (masks and eye protection, or face shields, or mask with visor attachment) should be worn when within two metres of a patient suspected or confirmed with MERS-CoV infection.
In a shared room/cohort setting of patients with confirmed MERS-CoV infection, facial protection may be worn for the care of successive patients.
Wearing a respirator is recommended when performing aerosol generating medical procedures on a patient suspected or confirmed with MERS-CoV infection (refer to Section 12).
Gloves, gown and facial protection should be removed before leaving the patient's room and discarded into a hands-free receptacle.
The respirator should be removed after leaving the patient’s room and discarded in a hands-free waste receptacle.
Hand hygiene should be performed after removing gloves and gown, before removing facial protection and respirator, and upon exiting the patient’s room.
AGMPs should be performed on patients suspected or confirmed to have MERS-CoV infection only if medically necessary. The number of HCWs present during an AGMP should be limited to only those essential for patient care and support. A respirator and face/eye protection is recommended for all HCWs present in a room where an AGMP is being performed on a patient suspected or confirmed to have MERS-CoV infection.
AGMPs should be performed in airborne infection isolation rooms, whenever feasible. If not feasible, AGMPs should be carried out using a process and in an environment that minimizes the exposure risk for HCWs, ensuring that non-infected patients/visitors and others in the healthcare setting are not unnecessarily exposed to the MERS-CoV virus.
All equipment/supplies should be identified and stored in a manner that prevents use by or for other patients. Reusable non-critical equipment (e.g., blood pressure cuffs, stethoscopes, pulse oximeters, commodes, bedpans, walkers, etc.), along with toys, electronic games, personal effects, etc. should be dedicated to the use of the patient, and should be cleaned and disinfected before reuse with another patient. Single-use devices should be discarded in a hands-free waste receptacle after use.
Hospital-grade cleaning and disinfecting agents are sufficient for environmental cleaning for the MERS-CoV virus. All horizontal and frequently touched surfaces should be cleaned at least twice daily and when soiled. The healthcare organization’s terminal cleaning protocol for cleaning of the patient’s room following discharge, transfer, or discontinuation of contact and droplet precautions should be followed.
No special precautions are recommended; routine practices are sufficient.
No special precautions are recommended; routine practices are sufficient.
Contact and droplet precautions for patients with MERS-CoV infection should be discontinued upon resolution of symptoms, or in accordance to provincial/territorial guidance or the organization’s policy. The duration of precautions should be determined on a case-by-case basis when patient symptoms are prolonged or when the patient is immune suppressed. The patient with persistent symptoms should be re-evaluated for underlying chronic disease or a secondary infection. Repeat microbiological testing may sometimes be warranted. Discontinuation of precautions should be made in conjunction with the infection prevention and control professional or delegate.
All HCWs should receive education on the MERS-CoV, including measures to control its spread and to reinforce routine practices, contact and droplet precautions, and safe work practices (e.g., no eating or drinking in patient care areas).
Patients, families/visitors should receive education about the precautions being used; the duration of precautions; the prevention of transmission of infection to others; and use of appropriate PPE.
Individuals with symptoms of an acute respiratory infection should be referred for medical assessment and restricted from visiting except for compassionate reasons. Those who do visit should be instructed in respiratory hygiene, use of PPE, and performing hand hygiene, and should limit their movement within the facility by visiting the patient directly and exiting directly after the visit.
Visitors should be instructed to speak with a nurse before entering the room of a patient on contact/droplet precautions to evaluate the risk to the health of the visitor and the ability of the visitor to comply with precautions, including PPE and hand hygiene. The number of visitors for a patient on contact/droplet precautions should be minimized to essential visitors (e.g., immediate family member/parent, guardian or primary caretaker) only. Visitors should be restricted to visiting only one patient who is on contact/droplet precautions. If the visitor must visit more than one patient, the visitor should be instructed to use PPE as HCWs and perform hand hygiene before going to the next patient’s room.
Routine practices should be used, along with contact precautions as required, for handling deceased bodies, preparing them for autopsy, or transferring them to mortuary services.
Prior to any patient interaction, all healthcare workers (HCWs) have a responsibility to always assess the infectious risk posed to themselves and to other patients, visitors, and HCWs. This risk assessment is based on professional judgment about the clinical situation and up-to-date information on how the specific healthcare organization has designed and implemented engineering and administrative controls, along with the availability and use of personal protective equipment (PPE).
Point-of-Care Risk Assessment (PCRA) is an activity that should be performed by the HCW before every patient interaction, to:
PCRA is not a new concept, but one that is already performed regularly by HCWs many times a day for their safety and the safety of patients and others in the healthcare environment. For example, when a HCW assesses a patient and situation to determine the possibility of blood or body fluid exposure or chooses appropriate PPE to care for a patient with an infectious disease, these actions are both activities of a PCRA.