title: Infection control and prevention practices implemented to reduce transmission risk of Middle East respiratory syndrome-coronavirus in a tertiary care institution in Saudi Arabia.
abstract: Transmission of Middle East respiratory syndrome-coronavirus (MERS-CoV) among health care workers (HCWs) and patients has been documented with mortality rate approximating 36%. We propose advanced infection control measures (A-IC) used in conjunction with basic infection control measures (B-IC) help reduce pathogen transmission. B-IC include standard and transmission-based precautions. A-IC are initiatives implemented within our center to enhance effectiveness of B-IC.
  
  
  
  Study effectiveness of combining B-IC and A-IC to prevent transmission of MERS-CoV to HCWs.
  
  
  
  A retrospective observational study was undertaken. A-IC measures include administrative support with daily rounds; infection control risk assessment; timely screening, isolation, and specimen analysis; collaboration; epidemic planning; stockpiling; implementation of contingency plans; full personal protective equipment use for advanced airway management; use of a real-time electronic isolation flagging system; infection prevention and control team on-call protocols; pretransfer MERS-CoV testing; and education.
  
  
  
  A total of 874 real-time polymerase chain reaction MERS-CoV tests were performed during the period beginning July 1, 2013, and ending January 31, 2015. Six hundred ninety-four non-HCWs were tested, of these 16 tested positive for MERS-CoV and their infection was community acquired. Sixty-nine percent of the confirmed MERS-CoV-positive cases were men, with an average age of 56 years (range, 19-84 years). Of the total tested for MERS-CoV, 180 individuals were HCWs with zero positivity.
  
  
  
  Adhering to a combination of B-IC and A-IC reduces the risk of MERS-CoV transmission to HCWs.
authors.affiliation: Department of Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Saudi Arabia. Electronic address: tbutt@kfshrc.edu.sa.
authors.forename: Taimur S
authors.initials: TS
authors.lastname: Butt
authors.affiliation: Infection Control and Hospital Epidemiology, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
authors.forename: Irene
authors.initials: I
authors.lastname: Koutlakis-Barron
authors.affiliation: Infection Control and Hospital Epidemiology, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
authors.forename: Suliman
authors.initials: S
authors.lastname: AlJumaah
authors.affiliation: Section of Microbiology, Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
authors.forename: Sahar
authors.initials: S
authors.lastname: AlThawadi
authors.affiliation: Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
authors.forename: Saleh
authors.initials: S
authors.lastname: AlMofada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018352:Coronavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012308:Risk Management; D012529:Saudi Arabia / Q000453:epidemiology; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Health care worker; Infection prevention; MERS-CoV; Occupational exposure