dato' dr azmi mers-cov 05072013

MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS

(MERS-CoV) – HOSPITAL PREPAREDNESS

Taklimat Pelaksanaan Aktiviti Kesiapsiagaan Menghadapi

Jangkitan MERS-CoV di Malaysia

5 Julai 2013

Institut Pengurusan Kesihatan

Medical Development Division,Ministry of Health Malaysia

MERS-CoV

1) Surat edaran Ketua Pengarah Kesihatan No. Ruj. (4) dlm. KKM-171/BKP/12/56/0826 bertarikh 11 Oktober 2012

2) Surat edaran Timbalan Ketua Pengarah Kesihatan (Kesihatan Awam)

No. Ruj.(6) dlm. KKM-171/12/56/0826 bertarikh 22 Mac 2013

3) Surat edaran Ketua Pengarah Kesihatan No. Ruj. (9) dlm. KKM-171/BKP/12/56/0826 bertarikh 14 Jun 2013

‘MAKLUMAN STATUS TERKINI MENGENAI KEJADIAN JANGKITAN NOVEL CORONAVIRUS’

3 circulars on MERS-CoV issued since September 2012


MERS-CoV

provide clear information related to MERS-CoV infection to health care workers under their supervision

ensure that hospital staffs involve in managing suspected patients (ie ED, Medical Dept/ID, Paeds Dept, ICU) are informed about the preparedness measures planning and further actions could be taken

ROLE OF TPKN (PERUBATAN), HOSPITAL DIRECTORs &

CLINICIANS


MERS-CoV

o Widespread of virus

o Source of virus

o Route of transmission

o Mode of transmission

o Clinical Pattern

o Course of disease

UNKNOWN

EXTRA CAREFUL….PROTECT OUR HCWS & PATIENTS


MERS-CoV

There is no specific treatment. Only symptomatic & supportive treatment

Evidence of non-sustained human-to-human transmission Communities: sporadic cases with unknown

exposure Families: contact with infected family members Health care facilities: patients & health care

workers

HCW in Saudi Arabia: 7 infected (1 critical, 2 stable, 4 asymptomatic)

HUMAN-TO-HUMAN TRANSMISSION


MERS-CoV

Screening & triaging Infection Prevention & Control Stockpile for PPE Hospital facilities Hospital Admission Case Notification Laboratory diagnosis

Hospital preparedness in managing mers-cov


MERS-CoV

shall be implemented in the Outpatient Department (OPD) and Emergency Department (ED) in all hospitals

Screening and 'triaging'


MERS-CoV

Appropriate infection prevention & control measures shall be strengthened and conducted in all hospitals Risk of exposing our healthcare workers & other inpatients to

infection if the infection control measures are not well in place Minimize the possibilities of spreading the disease

HIACC (Head of Infection Control Committee) at each state to take lead, with the help of State Coordinator of Infection Control Nurse at each state

(JKN/Hosp) Infection control nurses at all MOH hospitals

INFECTION PREVENTION & CONTROL


MERS-CoV

NEGERI PENGERUSI JAWATAN HOSPITAL

PERLIS Dr Jamaludin bin Mohamad Ketua Jabatan PediatrikHospital Tuanku Fauziah,

Kangar

KEDAH 1) Dr. Low Lee Lee2) Dr. Noraini Ismail

-Pakar Perubatan Penyakit Berjangkit

-Pakar Perunding (Microbiologi)

Hospital Sultanah Bahiyah Alor Setar

PULAU PINANG Dr Revathy NallusamyPakar Perunding & Ketua

Jabatan PediatrikHospital Pulau Pinang

PERAK Dr Ker Hong BeePakar Perubatan dan Penyakit Berjangkit

Hospital Raja Permaisuri Bainun, Ipoh

SELANGOR Dr Shanaz Shah Firdaus Khan Pakar NefrologiHospital Tengku Ampuan

Rahimah, Klang

WPKL Dr Kamarul Azhar Mohd Razali

Pakar Perunding Pediatrik dan Penyakit Berjangkit

Hospital Kuala Lumpur

N. SEMBILAN Dr Tan Kah KeePakar Perunding Pediatrik dan Penyakit Berjangkit &

Ketua Jabatan Pediatrik

Hospital Tuanku Jaafar, Seremban

HEAD OF STATE infection control COMMITTEE

MERS-CoV


MELAKA Dr Nor Hayati ShaharuddinPakar Perubatan (Penyakit

Berjangkit) Hospital Melaka

PAHANG YBhg. Dato’ Dr Hj Sapari Satwi

Pakar Perunding & Ketua Jabatan Perubatan

Hospital Tengku Ampuan Afzan, Kuantan

JOHOR YBhg. Datin Dr. R. GaneswriePakar Perunding Patologi &

Ketua Unit MikrobiologiHospital Sultanah Aminah,

Johor Bahru

KELANTAN 1) Dr. Mahiran Mustafa2) Dr. Nurahan Maning

-Pakar Perunding Perubatan Kanan (Penyakit Berjangkit)

-Pakar Perunding Kanan Mikrobiologi Klinikal

Hospital Raja Perempuan Zainab II, Kota Bahru

TERENGGANU1) YBhg. Dato' Dr. Hj. Abdul

Jamil Abdullah2) Dr. Ahmad Kashfi Abdul

Rahman

-Pakar Perunding Pembedahan

-Pakar Perunding Perubatan (Penyakit Berjangkit)

Hospital Sultanah Nur Zahirah, K. Terengganu

SABAH 1) Dr. Foong Siew Moi2) Dr. Timothy William

-Pakar Perunding Pediatrik (Penyakit Berjangkit)

-Pakar Perunding Perubatan (Penyakit Berjangkit)

-Hospital Wanita dan Kanak-kanak Likas

-HQE, KK

SARAWAK Dr. Chua Hock HinPakar Perunding Perubatan

(Penyakit Berjangkit)Hospital Umum Sarawak

Head OF STATE infection control COMMITTEE

MERS-CoV

NEGERI PENGERUSI JAWATAN JKN/HOSPITAL

PERLIS Pn Sariana Bt Radzi Penyelia Jururawat KesihatanJabatan Kesihatan Negeri

Perlis

KEDAH Mahinder Kaur a/p Pritam Singh

Ketua Penyelia Jururawat Negeri Gred U 44

Jabatan Kesihatan Negeri Kedah Darul Aman

PULAU PINANG Pn Hafizah binti HamzahKetua Jururawat Kawalan

InfeksiUnit Kawalan Infeksi, Hospital Pulau Pinang

PERAK Pn Rosena binti HassanPenyelia Jururawat Kawalan

Infeksi U 36

Unit Kawalan Infeksi, Hospital Raja Permaisuri

Bainon, Ipoh

SELANGOR Pn Ng Siew Koon Penyelia Jururawat U44 JKN Selangor

WPKL Pn Marina IdiKetua Jururawat Kawalan

InfeksiUnit Kawalan Infeksi,

Hospital Kuala Lumpur

WP PUTRAJAYA Pn Zaiton Noordin Penyelia Jururawat U36Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur

N. SEMBILAN Pn Selvarani a/p Palany Penyelia Jururawat U42 JKN Negeri Sembilan

INFECTION CONTROL NURSE : state coordinator

MERS-CoV


MELAKA Pn Teh Siew FahKetua Jururawat Kawalan

InfeksiUnit Kawalan Infeksi,

Hospital Melaka

PAHANG Pn Jama'iah binti Alang Abd Rais

Penyelia Jururawat U42 JKN Pahang (Perubatan)

JOHOR Pn Rohaida Abdullah Ketua Jururawat U32Unit Kawalan Infeksi,

Hospital Sultanah Aminah, JB

KELANTAN Pn Wan Maimunah binti Wan Yusoff

Penyelia Jururawat U42 Bhg Perubatan, JKN Kelantan

TERENGGANU Pn Fadilah binti Hassan Ketua Jururawat U32Unit Kualiti, Bahagian

Perubatan, JKN Terengganu

SABAH Pn Latifah Muh Noor Penyelia Jururawat U36Unit Kualiti Penjagaan Kesihatan, Bahagian

Perubatan, JKN Sabah

SARAWAK Fu Choon Kee Penyelia Jururawat U42 Hosp Umum Sarawak

WP LABUAN Pn Anih binti Gapar Ketua JururawatUnit Kawalan Infeksi,

Hospital Nukleus Labuan

INFECTION CONTROL NURSE : state coordinator

MERS-CoV

Stocks of personal protective equipment (PPE) for MERS-CoV infection in each state and hospital shall be kept at a sufficient level

To liase with Pharmaceutical Services Division MOH and at each state on PPE stockpiles


MERS-CoV

Stockpile for PPE

Ensure the hospital facilities/equipments for handling patients especially in isolation rooms and intensive care units to be functioning at the optimal level

HospitAL FACILITIES


MERS-CoV

TYPE OF HOSPITAL TOTAL

HOSPITAL WITH ...

NEGATIVE PRESSURE

ISOLATION ROOMS

VENTILATOR FACILITIES IN

INTENSIVE CARE SETTINGS

State Hospital 14 14 14

Major Specialist 25 15 24

Minor Specialist 24 9 20

Non-specialist 69 10 0

Special hospital/institution

9 2 0

OVERALL TOTAL 141 50 58

HospitAL FACILITIES

MERS-CoV

Hospital admissions : refer ‘Criteria for Hospital Admission’ Clinical assessment tool Co-morbidities & risk factors

Admission to any nearest MOH hospital non-specialist hosp MO to inform & consult specialist’s opinion for

further Mx

Urgent referral and transfer to the respective hospital to be done if the nearest hospital doesn’t have any of the facilities needed (ICU, isolation rooms)

Non-MOH Hospitals to admit & manage patients

Admission policies will be updated from time to time

HOSPITAL ADMISSION


MERS-CoV

Flowchart for management of severe acute respiratory infections when mers-cov is

suspectedMERS-CoV

Notification process shall follow the procedures used currently by using the form ‘Notification Form For MERS-CoV

Case’ as Lampiran 5 KKM/BKP/NCoV/2013/1

Case notification


MERS-CoV

Current services : IMR & MKAK Sg Buloh

Expansion of laboratory services : Tentative date to start MERS-CoV laboratory diagnosis

services 1 August 2013: 12 state hospitals:

-HPP -HRPB Ipoh - H. Sg Buloh – HKL

-H. Melaka - HTAA Kuantan - HSAJB - HRPZ II, K. Bahru,

-HSNZ, K. Tganu -HUS, Kuching - HTJ Seremban - HSB A.Setar MKA Kota Kinabalu

Any positive results of MERS-CoV shall be reported immediately to National CPRC and the relevant hospitals or institutions

LABORATORY DIAGNOSIS


MERS-CoV

Flowchart of specimen collection for mers-cov laboratory

diagnosis


MERS-CoV

CURRENT

Action plan is very important to minimize the impact on the morbidity and mortality due to the MERS-CoV

State level commitment required at earlier stage

Public response : panic , complaints and unhappiness among the public how patients is being treated overcrowding of the clinic & ED patients waiting for a longer time health staff not sure what needed to be done generally, to the way the pandemic is being managed

Sudden surge in the number of patients coming to the hospital and clinics. Extra efforts should be taken to provide a better facilities( eg waiting area) &

better methods of managing patients despite limited resources

LESSONS LEARNT FROM H1N1 PANDEMIC 2009


MERS-CoV

State Directors to take lead in addressing issues on the ground:

‘turun padang’ analyse the situation & suggest remedial measures

to assist Hospital Directors in addressing the related problems & issues

analyse our capacity and facilities eg if there is a needs for ‘redeployment’ of the staff and equipmenst, to be done accordingly

conduct sessions with HCW within MOH and non-MOH hospitals/ private hospitals/GPs with inputs from State Physician

for better understanding

strengthened involvement of private practioners/hospitals

engage the state government and the various agencies, activate an interagency meeting

Take home messages


MERS-CoV

Hospital Directors & clinicians : working hand in hand

Some of the activities in the hospitals have to be adjusted accordingly

HCW to be well-informed about the preparedness measures Screening & triaging Infection Prevention & Control Stockpile for PPE & medication Optimize hospital facilities & capacity (eg ED, wards, isolation

rooms, ICUs, laboratory services) Case notification Keep HCW updated on the latest directive from MOH

Take home messages


MERS-CoV

State physician/ Senior physician in the state to take lead in coordinating the patients’ management within the hospitals and clinics

(OPD) the involvement of the private GPs & private hospitals

Involvement of the private practitioners and private hospitals need to be strengthened able to take part and actively involved in managing

MERS-CoV

Take home messages


MERS-CoV

THANK YOU


dato' dr azmi mers-cov 05072013

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