MERS Protocol

1.  Any patient with travel history (14 days) to the Arabian peninsula (Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen).presenting with fever (>=100.5 F) and respiratory symptoms (cough, shortness of breath) OR pneumonia (chest x-ray finding)

2.  Any patient with travel history (14 days) to South Korea with fever and contact with an ambulatory or inpatient medical facility.

3.  Any patient with fever and contact with a traveler to either the Arabian peninsula or South Korea that has met or potentially fulfills the above criteria

Patients should be placed on airborne, contact and faceshield precautions; the ED should contact IPaC or the NYC DoH and report as a possible MERS PUI (person under investigation).  If, the ED contacts the DoH directly, they should still contact IPaC for subsequent reporting to the DoH.

I’m available to the ED off hours and Saturday.  there is an IPaC nurse in the hospital on Sunday.

The DoH will “advise” as to whether the patient will be worked up as a MERS PUI.

As the DoH decision to test will likely span a day(s), the patient will likely leave the ED and go to either the floor or an ICU depending on the clinical judgment of the ED attending.  If, the patient proceeds to a non-icu area, the nursing supervisor should be contacted to provide faceshields to the target admission area.

Additionally,
a log should be kept of all staff and visitors entering the room(s) where the patient is kept.
Visitors should be limited to 2, until we’ve ruled out MERS or the PUI status has been lifted
Visitors should wear surgical masks with shields NOT N95 respirators
The DoH will likely want an induced sputum, a nasopharyngeal culture and a red top for PCR.  These should be kept in accessioning for DoH pick up

Nota bene: a traveler from an affected area falling within the target time span with bacterial bronchitis may have fever and a negative x-ray in the setting of respiratory symptoms.  This case would qualify for PUI.  For the DoH, the decision to perform or not perform a test can be leisurely discussed, but for hospital staff, there is no difference between a rule-out case and a true case.

thank you

George Alonso, M.D.
Director, Infection Prevention and Control (IPaC)
Elmhurst Hospital Center
718 334-3078
email alonsog@nychhc.org