Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015

Abstract

OBJECTIVESDuring the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC.METHODSWe reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure.RESULTSThe healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR.CONCLUSIONSThe possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.

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“…One retrospective cohort study has reported that one of nine HCWs who participated in cardiac compression developed severe acute respiratory syndrome (SARS) [25]. Of the six HCWs who performed CPR on a patient with MERS, one acquired the infection [11]. Experiences from the outbreaks of highly contagious diseases, such as SARS and MERS, taught us that HCWs should be protected from airborne disease transmission when performing CPR [11,12,26,27].…”

“…Of the six HCWs who performed CPR on a patient with MERS, one acquired the infection [11]. Experiences from the outbreaks of highly contagious diseases, such as SARS and MERS, taught us that HCWs should be protected from airborne disease transmission when performing CPR [11,12,26,27]. The current international CPR guidelines do not address the extent of airway protection required by HCWs when performing CPR on patients with suspected or confirmed airborne diseases [22].…”

“…The current international CPR guidelines do not address the extent of airway protection required by HCWs when performing CPR on patients with suspected or confirmed airborne diseases [22]. Infection-prevention strategies for HCWs tend to take second place in life-threatening situations requiring minimization of noflow time [11,12]. However, the safety of HCWs is in fact paramount.…”

“…Cardiopulmonary resuscitation (CPR), a common ED procedure, generates infectious aerosols, and this is associated with an https://doi.org/10.1016/j.ajem.2019.03.041 0735-6757/Ó 2019 Elsevier Inc. All rights reserved. increased risk of pathogen transmission to HCWs [11,12]. Some exercises for the conventional QNFT mimic chest compression, which include bending at the waist and head up-and-down movement [9].…”

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“…Eine erste systematische Übersichtsarbeit und Metaanalyse von Studien über das Risiko der SARS-Übertragung durch AGPs wurde 2011 vonTran et al vorgelegt [14]. Darin werteten die Autoren je 5 klinische Fall-Kontroll-und retrospektive Kohortenstudien vongemessen an den GRADE-Kriterien[13] sehr geringer Qualität aus und fanden signifikant erhöhte Infektionsrisiken nur für folgende AGPs: ▪ Intubation (8 Studien, Gesamt Odds Ratio, OR 6,6) Übertragung von MERS auf eine Krankenpflegerin im Rahmen einer Reanimation berichtet[16,17]. Der Bericht lässt allerdings offen, ob die Übertragung tatsächlich durch Aerosole erfolgte oder auf anderen Wegen, z.…”