Tuesday, May 07, 2013

WHO: Interim Infection Control Guidance On nCoV (MERS)


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# 7241


The World Health Organization has released Interim Infection control guidance for the nCoV (MERS) virus based on the limited information available from the small number of cases (n=30) that have been detected to date.


I’ve only excerpted a small portion, follow the link to read it in its entirety.



Interim guidance for infection prevention and control during health care for probable or confirmed cases of novel coronavirus (nCoV) infection

pdf, 164kb   06 May 2013


In addition to Standard Precautions, all individuals, including visitors and HCWs, when in close contact (within 1 m) or upon entering the room or cubicle of patients with probable or confirmed nCoV infection should always:

  • wear a medical mask14;
  • wear eye protection (i.e. goggles or a face shield);
  • wear a clean, non-sterile, long-sleeved gown; and gloves (some procedures may require sterile gloves);
  • perform hand hygiene before and after contact with the patient and his or her surroundings and immediately after removal of PPE.

If possible, use either disposable equipment or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers). If equipment needs to be shared among patients, clean and disinfect it between each patient use. HCWs should refrain from touching their eyes, nose or mouth with potentially contaminated gloved or ungloved hands.


Place patients with probable or confirmed nCoV infection in adequately ventilated single rooms or Airborne Precaution rooms; if possible, situate the rooms used for isolation (i.e. single rooms) in an area that is clearly segregated from other patient-care areas. When single rooms are not available, put patients with the same diagnosis together. If this is not possible, place patient beds at least 1 m apart.

In addition, for patients with probable or confirmed nCoV infection:

  • Avoid the movement and transport of patients out of the isolation room or area unless medically necessary. The use of designated portable X-ray equipment and other important diagnostic equipment may make this easier. If transport is required, use routes of transport that minimize exposures of staff, other patients and visitors.
  • Notify the receiving area of the patient's diagnosis and necessary precautions as soon as possible before the patient’s arrival.
  • Clean and disinfect patient-contact surfaces (e.g. bed) after use18.
  • Ensure that HCWs who are transporting patients wear appropriate PPE and perform hand hygiene afterwards.

In low-resource countries, not all suspected nCoV patients will be admitted to health-care facilities. They may prefer to stay in their homes to avoid the extra cost to their families of transportation and of living away from home. WHO publications are available for patient care at home and in the community.19,20,21

Duration of isolation precautions for nCoV infection

The duration of infectivity for nCoV infection is unknown. While Standard Precautions should continue to be applied always, additional isolation precautions should be used during the duration of symptomatic illness22 and continued for 24 hours after the resolution of symptoms. Given that little information is currently available on viral shedding and the potential for transmission of nCoV, testing for viral shedding should assist the decision making when readily available. Patient information (e.g. age, immune status and medication) should also be considered in situations where there is concern that a patient may be shedding the virus for a prolonged period.

(Continue . . .)



This document recommends `medical masks’ (defined as disposable surgical or procedure mask) - as opposed to the more protective N95 respirators - for healthcare workers (HCWs) in close proximity to suspected or confirmed nCoV cases.


By way of comparison, a couple of weeks ago the CDC  released Interim H7N9 Infection Control Guidelines, that called for fitted N95 respirators, gowns, gloves, and eye protection as a minimum level of PPEs (personal protective equipment) for all HCWs who may have contact with potential or confirmed H7N9 patients.


Given the high mortality rate, and lack of vaccine for nCoV, I would imagine that many HCWs will view medical masks as not being protective enough.



But in terms of practicality, many resource-limited nations would find it difficult to come up with enough surgical masks, much less N95s, to deal with an outbreak of any size.


Making it problematic, I'm sure,  to recommend a minimum level of protection that - for many medical environments - would simply be impossible to achieve.


As we’ve discussed before, in any severe pandemic, the world’s supply of PPEs would be quickly put under stress. 


Our Strategic National Stockpile contains well over 100 million  N95 and surgical masks (see Caught With Our Masks Down), but it is expected that the demand for PPEs during any severe pandemic would eventually exhaust that supply. 


Which means that, as the supply of N95 masks dwindles, some adjustments in how, and when they are used, would have to be made in order to maximize their supply.


For more on the, often contentious, debate over the efficacy of surgical masks versus N95s you may wish to revisit:


Influenza Transmission, PPEs & `Super Emitters’

Study: Aerosolized Influenza And PPEs

Study: Longevity Of Viruses On PPEs

Why Size Matters

IOM: PPEs For HCWs 2010 Update