MoH Training Manual – v1.6 20140901

MERS-CoV infection control

Classroom session-Clinical

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We are here to stop the spread of MERS-CoV by fixing infection prevention and control in Saudi hospitals

Strict infection control is the only way to stop MERS-CoV from spreading – everyone of us is responsible and can help to stop the disease

▪ No vaccine

▪ No treatment

▪ High death rate

▪ Highly contagious in a hospital setting

▪ Hospital staff at high risk if not following infection control rules

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1. Maintain strict personal hygiene

2. Ensure proper use of PPE by staff and patient

3. Identify and isolate potential MERS-CoV patients early

4. Allocate adequate facilities for MERS-CoV patients

5. Follow appropriate housekeeping practices

6. Monitor staff health – don’t allow sick people at work

7. Implement stricter visitor policy

8. Send for home isolation under supervision, when possible

9. Ensure safe collection and handling of lab samples

10. Take precautions in the mortuary

Your 10 steps to fight MERS-CoV in your hospital

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You already know this, you just need to DO IT EVERY DAY

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; the Infection Control powerpoint

1. MAINTAIN STRICT PERSONAL HYGIENE

Cough etiquette

Short nails, no watches, no jewelry

▪ Avoid touching your face

▪ Avoid touching patient’s items

▪ Do not share personal items

▪ Shower after work

▪ Change uniform daily

▪ Keep home clean and ventilated

▪ If you feel sick, do not come to work – tell your senior over phone

▪ Avoid contact with sick colleagues

Other basics

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More on hand hygiene

SOURCE: WHO; Saudi Aramco John Hopkins

When to do it?

5 moments of hand hygiene

When hands are visibly soiled

After contact with a source of microorganisms (body fluids and substances, mucous membranes, non-intact skin, surfaces that are likely to be contaminated)

After removing gloves and before wearing them.

Before and after smoking, eating or preparing food

Before leaving the patient’s room

After bodily functions (e.g., using the toilet, blowing one’s nose, sneezing)

When moving from a contaminated body site to a clean body site during patient care

How to do it?

Use proper hand hygiene technique to disinfect all parts of your hands

1. MAINTAIN STRICT PERSONAL HYGIENE

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Correct technique – how to handrub and handwash (1/3)

SOURCE: WHO; Saudi Aramco John Hopkins

Alcohol-based handrub is more efficient than handwash when hands are not soiled

1. MAINTAIN STRICT PERSONAL HYGIENE

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SOURCE: WHO

1. MAINTAIN STRICT PERSONAL HYGIENE

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Hand washing Technique

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Droplet and contact precautions required when dealing with potential MERS-CoV patients; N95 to be worn during aerosol generating procedures

Potential/confirmed MERS-CoV: in patient’s room/close contact – contact and droplet precautions (for healthcare workers and visitors)

▪ Surgical mask (N95 for aerosol generating procedures)

▪ Eye protection (goggles/face shield)

▪ Gown (clean, non-sterile, long-sleeved)

▪ Gloves (some procedure may require sterile gloves)

▪ Impermeable apron (for procedures with expected splashes)

2. ENSURE PROPER USE OF PPE BY STAFF AND PATIENTS

May be considered if resources permit:

▪ Airborne precautions with all potential/confirmed MERS-CoV patients (N95)

▪ Surgical mask for all fever/respiratory patients at the ER entrance

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; CDC pictures

Safely remove PPE and perform hand hygiene when leaving the MERS-CoV precautions area (e.g., isolation or procedure room)

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N95 provides protection only if appropriately used

Do not use N95 with valves

…When working in a sterile field such as an operating room

Never wear a medical mask under the N95 mask as this prevents proper fitting and sealing of the N95 mask thus decreasing its efficacy.

Conduct fit test for your N95

N-95 mask comes in different sizes and offers no protection if not properly fitted

Fit test has to be performed for employees wearing N95 to ensure proper fit

How to fit test N95 mask: https://www.youtube.com/watch?v=7IAsoU6h-8g

Source: Saudi Aramco Johns Hopkins

Inspect your N95 every time before wearing

▪ For structural integrity

▪ Ensure that the straps are not cut or damaged

▪ Make sure the metal nose clip is in place and functions properly

▪ Determine if it is physically damaged or soiled

How to wear N95 mask: http://www.youtube.com/watch?v=bo-PEzHE7iw

2. ENSURE PROPER USE OF PPE BY STAFF AND PATIENTS

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Extended use refers to the practice of wearing the same N95 respirator for repeated

close contact encounters with several patients, without removing the respirator between patient encounters.

Extended use may be implemented when multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards.

* Discard N95 respirators following use during aerosol generating procedures.

* Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.

* Perform hand hygiene with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).

Extended Use of N95 Filtering, face piece, respirators in healthcare settings:

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Reuse of N95 filtering, face piece, respirators in Health care settings

Reuse refers to the practice of using the same N95 respirator for multiple encounters with patients but removing it (“doffing”) after each encounter. The respirator is stored in between encounters to be put on again (“donned”) prior to the next encounter with a patient.

• Discard N95 respirators following use during aerosol generating procedures.

• Discard N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.

*Store respirators in a single disposable paper container with identification.

•Clean hands with soap and water or an alcohol-based sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).

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•Clean hands with soap and water or an alcohol-based sanitizer before and after touching or adjusting the respirator (if necessary for comfort or to maintain fit).

Clean hands with soap and water or an alcohol-based sanitizer after donning a used N95 respirator and performing a user seal check.

• Follow the manufacturer’s user instructions, including conducting a user seal check.

• Maximum number of donning up to five times if the manufacturer does not provide a recommendation.

• Discard any respirator that is obviously damaged or becomes hard to breathe through.

*Pack or store respirators between uses so that they do not become damaged or deformed.

Reuse continued:

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Veil and beard with the N95 mask

VEIL

For female staff who wear veils, the medical or N95 mask should always be placed directly on the face behind the veil and not over the veil. In this instance a face shield should also be used along with the mask.

BEARD

N95 does not provide full protection for people with beards – use alternative respirator such as powered air purifying respirator, should be used.

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SEQUENCE FOR DONNING PERSONAL PROTECTIVE EQUIPMENT ( PPE )

The type of PPE used will vary based on the level of precautions required: e.g., Standard and Contact, Droplet or Airborne Infection Isolation.

1. GOWN• Fully cover torso from neck to knees, arms to end of wrists• , and wrap around the back• Fasten in back of neck and waist

2. MASK OR RESPIRATOR• Secure ties or elastic bands at middle of head and neck • Fit flexible band to nose bridge• Fit snug to face and below chin• Fit-check respirator

3. GOGGLES OR FACE SHIELD• Place over face and eyes and adjust to fit

4. GLOVES• Extend to cover wrist of isolation gown

USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION

■ Keep hands away from face ■ Limit surfaces touched ■ Change gloves when torn or heavily contaminated ■ Perform hand hygiene

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SOURCE: CDC (http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf)

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SEQUENCE FOR DOFFING ( removing ) PERSONAL PROTECTIVE EQUIPMENT ( PPE )

Except for respirator, remove PPE at doorway or inside the patient’s room.Remove respirator after leaving patient room and closing door (anteroom).1. GLOVES• Outside of gloves is contaminated! • Grasp outside of glove with opposite gloved hand; peel off• Hold removed glove in gloved hand • Slide fingers of ungloved hand under remaining glove at wrist• Peel glove off over first glove• Discard gloves in waste container

HAND HYGIENE COULD BE PERFORMED AFTER EVERY STEP OF REMOVAL OF SUSPECTED CONTAMINATED PPE

SOURCE: CDC (http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf)

2. GOGGLES OR FACE SHIELD • Outside of goggles or face shield is contaminated!• To remove, handle by head band or ear pieces• Place in designated receptacle for reprocessing or in waste container

3. GOWN • Gown front and sleeves are contaminated!• Unfasten ties• Pull away from neck and shoulders, touching• inside of gown only• Turn gown inside out• Fold or roll into a bundle and discard

4. MASK OR RESPIRATOR ( done outside of the room ) • Front of mask/respirator is contaminated —• DO NOT TOUCH!• Grasp bottom, then top ties or elastics and remove• Discard in waste container

*Perform Hand Hygiene* WHO STATES HAND HYGIENE BEFORE PUTTING ON GLOVES AND IMMEDIATELY AFTER REMOVING GLOVES

*Perform Hand Hygiene*

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Promptly identify symptomatic patients at the hospital entry and take MERS-CoV precautions until recovery, regardless of test results

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014

1 Acute respiratory infections – symptoms including runny nose, sneezing, coughing, shortness of breath 2 In hospital or home3 And no alternative confirmed diagnosis / still suspicion for MERS – for multiple reasons, negative tests do not fully rule out possibility of MERS-CoV

Patients with fever, ARI1, diarrhea and other

Take precautions for MERS-CoV▪ PPE for staff and source control for patient ▪ Isolation2

Test for other pathogens. If patient meets MERS-CoV case definition, also test for MERS-CoV

Take precautions for MERS-CoV until symptoms resolve▪ PPE for staff and source control for patient▪ Isolation2

MERS-CoV positive MERS-CoV negative3

3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS

When possible

▪ Identify symptomatic patients at the hospital entrance

▪ Allocate a separate room/area in ER for symptomatic patients

▪ Allocate separate procedure rooms for symptomatic patients

▪ Restrict visitors and do not rotate personnel in high risk MERS-CoV area

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MERS-CoV case definition has to be followed when testing for MERS-CoV

Suspect case (patients who should be tested for MERS-CoV)

I. A person with fever and community-acquired pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence

OR

II. A hospitalized patient with healthcare associated pneumonia based on clinical and radiological evidence

OR

III. A person with 1) Acute febrile (≥38°C) illness

AND

2) Body aches, headache, diarrhea, or nausea/ vomiting, with or without respiratory symptoms

AND

3) Unexplained leucopenia (WBC<3.5x10/L) and thrombocytopenia (platelets<150x10/L)

OR

IV. A person (including health care workers) who had protected or unprotected exposure to a confirmed or probable case of MERS-CoV infection and who presents with upper or lower respiratory illness within 2 weeks after exposure

▪ A probable case is a patient in category I or II with absent or inconclusive laboratory results for MERS-CoV and other possible pathogens who is a close contact of a laboratory-confirmed MERS-CoV case or who works in a hospital where MERS-CoV cases are cared for

▪ A confirmed case is a person with laboratory confirmation of MERS-CoV infection

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014

3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS

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Triage and screening for MERS-CoV

PATIENTS COMING TO THE

EMERGENCY ROOM

SCREENING FOR MERS SYMPTOMSThere should be a separate desk or room outside the ER

patient care area, where new patients are screened. Posters for patient to self-triage must be visible here. Visitors must be strictly controlled. The doctor & nurse here should wear surgical masks or N95 and follow

general precautions.

Send patient to the regular ER triage and waiting area.

1. Put regular mask on patient2. Shift to isolation room / area3. Give emergency treatment4. Test for MERS-CoV5. Based on clinical assessment,

Admit to MERS unit or send home with advice on hand washing, cough etiquette & home isolation

MERS SYMPTOMS NO SYMPTOMS

Follow MERS case definition criteria to identify cases

MERS MANAGEMENT

3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS

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Decision 1 – Is it an ARI patient (potential MERS)?

Practical tips▪ Allocate a separate isolated area for ARI patients in your ER▪ Ensure ER receptionist wears PPE (mask) and performs hand hygiene▪ Ensure everybody in ARI part of ER wears PPE (masks) and performs hand hygiene▪ Have signage and displays for patients, provide masks

▪ Apply standard precautions▪ Provide the patient with a medical mask▪ Lead the patient into designated waiting

area for ARI patients

Patient ER reception

YES

▪ Apply standard precautions▪ Lead the patient into general ER waiting

area

Patient ER reception

NO

Do you have any of these:

I feel sick. Help me!

Patient ER reception

SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014

3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS

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Decision 2 – Should we test for MERS?

SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014

Patient

NO CASE DEFINITION

CASE DEFINITION CONFIRMED

▪ Take nasopharyngeal swab for MERS-CoV test

▪ Place patient into isolated single room

▪ Treat the patient based on his/her healthcare needs

▪ Keep applying basic precautions (PPE etc.)

Acquire clinical or radiological evidence necessary to confirm MERS case definition

Practical tips▪ All radiological procedure should be done on site as long as possible

Physician

3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS

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Decision 3 – Isolate in the hospital or at home?

SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014

Test results

Physician

Take decision about further patient treatment based on test results, pre-sence of symptoms and patient’s living conditions

MERS POSITIVE

▪ Continue hospital isolation if– Patient has MERS

symptoms▪ Isolate at home1 if

– Patient has no MERS symptoms

MERS NEGATIVE

▪ Continue hospital isolation if– CD I or II, or– CD III or IV with

pneumonia▪ Isolate at home1 if

– CD III or IV without pneumonia

1 Home should be suitable for isolation based on Home Isolation Guidelines – if not suitable, keep in isolation in the hospital

3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS

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Decision 4 – When to discharge the patient?

Hospital isolation

Home isolation

Patient discharge criteria

▪ Patient is clinically well for 24 hours, and

– No clinical concern for viral shedding, or

– Repeated MERS CoV test is negative

▪ Repeated weekly test is negative

SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014

3. IDENTIFY POTENTIAL MERS-CoV PATIENTS EARLY AND TAKE PRECAUTIONS

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Place patient in isolation – 4. ALLOCATE ADEQUATE FACILITIES FOR MERS-CoV PATIENTS1

Patient placement requirement

▪ Place patients with suspected, probable or confirmed MERS-CoV infection who are not critically ill in adequately ventilated single room.

▪ Place patients with suspected, probable or confirmed MERS-CoV infection who are critically ill in a negative pressure room. If not available then single room with HEPA filter.

▪ The rooms used for isolation should be situated in an area that is clearly segregated from other patient-care areas

▪ When single rooms are not available, cohort – put patients with the same lab confirmed diagnosis together (i.e., taking into consideration positive MERS-CoV and other contagious diseases )

▪ Use HEPA-filters when negative pressure rooms not available

▪ Standard, contact & droplet precautions should be used for all suspected and confirmed patients.

▪ When an AGP is being anticipated air borne precautions should be added

More information: GCC Infection Control Manual GCC-ICM-III-03, 04, 05

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014

1 Both, potential and confirmed

MERS-CoV

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Housekeeping standards and rules should be followed5. FOLLOW APPROPRIATE HOUSEKEEPING PRACTICES

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014

Item sharing

▪ Use disposable or dedicated equipment when possible

▪ Clean and disinfect shared equipment between patients

▪ Discard single-use devices in a hands-free waste bin

Requirements

House-keeping standards

▪ Comply with the hospital’s standards and GCC Infection Control Manual on all procedures (cleaning, waste etc.)

▪ Follow PPE requirements for MERS-CoV or higher

▪ Use hospital approved disinfectants with approved dilution

Areas

▪ Clean all horizontal and frequently touched surfaces (incl. medical equipment) at least twice daily/once a shift

▪ Clean isolation areas last; when possible, change mop head after each isolation room, disinfect after each use

▪ Follow hospital’s terminal cleaning protocol for patient’s room when vacated by the previous patient. Replace curtains when terminal cleaning.

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Monitor staff health – identify and exclude symptomatic staff from work

SOURCE: CDC MERS-CoV recommendations

Recommendations

Healthcare facility

▪ Implement flexible non-punitive sick leave policies for staff

▪ Provide staff with quick access to medical consultation and treatment

▪ Screen all staff for MERS-CoV symptoms at the beginning of the shift

▪ Exclude symptomatic staff from work

▪ Dedicate the same staff to MERS-CoV patients

▪ Track staff exposure to MERS-CoV patients

▪ If resources permit, provide separate accommodation for staff with regular exposure to potential/confirmed MERS-CoV patients

Staff

▪ In general: – Monitor MERS-CoV symptoms– Report to supervisor if symptomatic

▪ If symptomatic– Do not come to work/stop working immediately– Notify supervisor– Wear surgical mask for source control– Seek prompt medical evaluation– Stay on leave until no longer infectious

▪ If asymptomatic but had unprotected close MERS-CoV exposure– Monitor symptoms– Wear surgical mask for source control (when not wearing N95)– Consider exclusion from work until found non-infectious

6. MONITOR STAFF HEALTH – DON’T ALLOW SICK PEOPLE AT WORK

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Limit the number of visitors and train them to comply with precautions7. IMPLEMENT STRICTER VISITOR POLICY

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014; CDC MERS-CoV recommendations

Visitor management requirement

▪ Limit the number of visitors and family members to those essential for patient support

Additional practices if resources permit

▪ Screen visitors for ARI symptoms at the hospital entrance

▪ Evaluate risk to visitors’ health (e.g., due to underlying illness) and ability to comply with precautions

▪ Instruct visitors on hand hygiene, potentially contaminated surfaces, and use of PPE, before entry into the patient care area and supply necessary equipment (e.g., surgical masks)

▪ Track (e.g., via logbook) all visitors to MERS-CoV patient rooms

▪ Allow no visitors during aerosol-generating procedures (and if possible, for one hour after)

▪ Limit visitor movement within the facility (e.g., visitors to MERS-CoV patient rooms should not visit other areas). A security personnel should be assigned outside any unit with suspected or confirmed cases to limit access to isolated patients.

1 Acute respiratory infections

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Patients with no shortness of breath, hypoxemia or pneumonia can be isolated at home, provided home facilities meet the requirements

SOURCE: KSA MoH MERS-CoV Home Isolation Guidelines, May 2014

8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE

Assess (by phone or direct observation) whether the home is appropriate for isolating the ill person

The home should have a functioning bathroom – ideally, one bathroom should be designated solely for the ill person

The ill person should have his or her own bed and preferably a private room for sleeping

Basic amenities, such as AC, electricity, potable and hot water, sewer, and telephone access, should be available

There should be a primary caregiver who can - Follow doctor’s instructions for medications and care- Help the ill person with basic needs

Follow MERS-CoV Home Isolation Guidelines for patient home care

requirements

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Home isolated patient needs to follow

SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014

Separate oneself from

other people in the house

Call ahead before visiting

doctor

Wear a medical mask

Cover coughs and sneezes

Avoid sharing household

items

Wash hands

Patient must…

8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE

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Family and caregivers have to take precautions

SOURCE: KSA MoH MERS Infection Prevention and Control Guidelines, May 2014

Health Care Providers Instructions

Limit the number of people at home

Be aware of them and help the ill person follow them

To only essential for providing care for the ill person

Other household members should stay in another place of residence. If this is not possible, stay separated from the ill person as much as possible and use separate utilities and household items

Make sure that shared spaces at home have good air flow, such as air conditioning and open windows

Clean all “high-touch” surfaces (counters, tabletops, toilets, etc.) while wearing appropriate PPE daily

Stay Separated

Restrict Visitors

Elderly People and Medical Conditions

Ventilation

PPE

Surfaces

Who do not have an essential need to be at home

Elderly people and people with medical conditions should stay away from the ill person

Wear appropriate PPE when in contact with the ill person’s body fluids. Dispose all PPE’s and contaminated items appropriately

Laundry and Household Items

Wash laundry and household items thoroughly and use detergents

Wash Your HandsWash your hands immediately after removing your medical mask, gown, gloves and at all times

8. SEND FOR HOME ISOLATION UNDER SUPERVISION, WHEN POSSIBLE

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MERS-CoV testing practices and lab procedures should follow strict PPE9. ENSURE SAFE COLLECTION AND HANDLING OF LAB SAMPLES

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014

1 Physicians or nurses, based on the hospital policy 2 When resources permit, negative pressure 3 Video on how to take nasopharyngeal swab: https://www.youtube.com/watch?v=hXohAo1d6tk 4 Jeddah, Riyadh, Dammam, Makkah, Medina

▪ Swabbing should be done based on MERS-CoV case definition

▪ Swabbing personnel1 should be properly trained on the technique and wear PPE appropriate for aerosol generating procedures

▪ Use well-ventilated2 (min 6-12 air changes/hour) separate room in line with aerosol generating procedures requirements

▪ Fill the test form completely

▪ Ensure that healthcare facility laboratories adhere to appropriate biosafety practices and transport requirements

Swabbing3

Transport

▪ Personnel who transports specimens should be trained in safe handling practices and spill decontamination

▪ Use leak-proof plastic biohazard specimen bags that have a separate sealable pocket for the specimen

▪ Maintain the temperature requirement (+4 degrees Celsius) for keeping the sample valid from collection till processing

▪ Notify the lab that the specimen is being transported

Responsibilities

All samples should be sent for testing to one of the 5 regional MoH labs4 unless otherwise specified (e.g., unless your hospital lab has acknowledged capabilities to run the PCR test for MERS-CoV)

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Ensure adequate level of PPE in the morgue and follow strict visitor policy

Morgue staff PPE Hand hygiene Gloves N95 respirator Impermeable/water resistant protective gown Boots/shoe covers Eye protection (if the body needs to be embalmed)

General requirements Body should be placed in impervious appropriately sized plastic body

bag Body washing must be done at the hospital morgue If the family members wish to perform the body washing, they must

adhere to the same precautions as body washers Inform the family members about the risks associated with removing the

body from the body bag

SOURCE: KSA MoH MERS-CoV Infection Prevention and Control Guidelines, May 2014

10. TAKE PRECAUTIONS IN THE MORTUARY

Deceased bodies pose a potential MERS-CoV infection risk

More information: GCC Infection Control Manual GCC-ICM-VIII-10

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Relevant videos

How to properly do hand hygiene? http://www.youtube.com/watch?v=uGmMDC-4IMY Disclaimer: Refer to WHO standards of hand hygiene for more information How to put on personal protective equipment (PPE)?http://www.youtube.com/watch?v=HIR88sJEI2s Disclaimer: Refer to the KSA MERS-CoV Infection Control Guidelines for exact protective equipment required while caring for suspected/confirmed MERS-CoV patients How to take off personal protective equipment (PPE)?http://www.youtube.com/watch?v=vYMWTWE4xqU Disclaimer: Refer to the KSA MERS-CoV Infection Control Guidelines for exact protective equipment required while caring for suspected/confirmed MERS-CoV patients How to wear the N95 mask? http://www.youtube.com/watch?v=bo-PEzHE7iw Disclaimer: There might be differences in mask design for different brands How to fit test the N95 mask? https://www.youtube.com/watch?v=7IAsoU6h-8gDisclaimer: There might be differences in mask design for different brands How to take nasopharyngeal swab for MERS-CoV?https://www.youtube.com/watch?v=hXohAo1d6tkDisclaimer: Healthcare worker swabbing the patients, needs to comply to PPE requirements of aerosol generating procedures as per the KSA MERS-CoV Infection Control Guidelines

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More information sources

E-mail suggestions about this presentation to corona@mohfeedback.com

KSA MoH website about MERS-CoV

http://www.moh.gov.sa/en/CoronaNew

KSA General Directorate for Infection Prevention and Control http://www.gdipc.org/

GCC Infection Prevention and Control Manual

http://www.gdipc.org/ic-manual.html

CDC on MERS-CoV

http://www.cdc.gov/CORONAVIRUS/MERS/INDEX.HTML

WHO on MERS-CoV

http://www.who.int/csr/disease/coronavirus_infections/en/

KSA MoH call center

8002494444 or 937 (toll free)