title: Outcome of strict implementation of infection prevention control measures during an outbreak of Middle East respiratory syndrome.
abstract: BACKGROUND
  The objective of this retrospective cohort study was to assess the impact of implementation of different levels of infection prevention and control (IPC) measures during an outbreak of Middle East respiratory syndrome (MERS) in a large tertiary hospital in Saudi Arabia. The setting was an emergency room (ER) in a large tertiary hospital and included primary and secondary MERS patients.
  
  
  METHODS
  Rapid response teams conducted repeated assessments of IPC and monitored implementation of corrective measures using a detailed structured checklist. We ascertained the epidemiologic link between patients and calculated the secondary attack rate per 10,000 patients visiting the ER (SAR/10,000) in 3 phases of the outbreak.
  
  
  RESULTS
  In phase I, 6 primary cases gave rise to 48 secondary cases over 4 generations, including a case that resulted in 9 cases in the first generation of secondary cases and 21 cases over a chain of 4 generations. During the second and third phases, the number of secondary cases sharply dropped to 18 cases and 1 case, respectively, from a comparable number of primary cases. The SAR/10,000 dropped from 75 (95% confidence interval [CI], 55-99) in phase I to 29 (95% CI, 17-46) and 3 (95% CI, 0-17) in phases II and III, respectively.
  
  
  CONCLUSIONS
  The study demonstrated salient evidence that proper institution of IPC measures during management of an outbreak of MERS could remarkably change the course of the outbreak.
authors.affiliation: Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia. Electronic address: bestregards.h@gmail.com.
authors.forename: Hassan E
authors.initials: HE
authors.lastname: El Bushra
authors.affiliation: Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Hussain A
authors.initials: HA
authors.lastname: Al Arbash
authors.affiliation: General Directorate for Control of Communicable Disease, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Mutaz
authors.initials: M
authors.lastname: Mohammed
authors.affiliation: General Directorate for Control of Communicable Disease, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Osman
authors.initials: O
authors.lastname: Abdalla
authors.affiliation: Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Mohamed N
authors.initials: MN
authors.lastname: Abdallah
authors.affiliation: Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Zayid K
authors.initials: ZK
authors.lastname: Al-Mayahi
authors.affiliation: Deputyship for Public Health, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Abdallah M
authors.initials: AM
authors.lastname: Assiri
authors.affiliation: Deputyship for Public Health, Ministry of Health, Riyadh, Saudi Arabia; King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdulaziz A
authors.initials: AA
authors.lastname: BinSaeed
mesh_terms: D018352:Coronavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D062606:Tertiary Care Centers
keywords: Impact; Infection prevention and control (IPC); Middle East Respiratory Syndrome (MERS); Outbreak; Saudi Arabia; Secondary attack rate