Lapses in Infection Control Associated with Spread of Severe Respiratory Virus MERS, According to Study

Washington, DC, December 1, 2014

Little is known about the often fatal virus known as Middle East respiratory syndrome coronavirus (MERS-CoV), but researchers have identified gaps in infection control as a major culprit in all eleven published cases involving healthcare-associated transmission of the virus.  The full findings of the review can be found in the December issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

Researchers from the Hellenic Center for Disease Control and Prevention in Athens, Greece, reviewed 252 papers on MERS-CoV, ultimately narrowing their focus to 10 studies covering 11 cases of possible or confirmed healthcare-associated transmission of the virus, which causes severe respiratory disease with a high fatality rate. Although the majority of cases have occurred in Middle Eastern countries since the virus first appeared in 2012, there have also been documented cases in Europe, Africa, and the United States. Two out of three affected patients have been male, with a median age of 49 years.

Healthcare workers (HCW), particularly nurses, are at heightened risk of acquiring MERS-CoV from infected patients from the environment and also through person-to-person contact. The virus has been shown to survive for at least 48 hours on hospital surfaces, and is transmissible through vomit and diarrhea, which present in roughly one-third of cases. MERS-CoV has been detected for up to 16 days in respiratory specimens and stool, and up to 13 days in urine.

"Patients with confirmed or suspected MERS-CoV infection should be cared for under contact and droplet precautions until testing results," the authors stress.  According to WHO guidelines, this includes wearing a high protection mask (e.g., N95 respirator), eye goggles, gowns, and gloves during aerosol-generating procedures. The U.S. Centers for Disease Control and Prevention recommends use of respirator masks when in contact with any MERS-CoV patient (suspected or confirmed).

Although the World Health Organization has identified infection control gaps within healthcare facilities as the reason behind these outbreaks, further research is needed to confirm whether these gaps concern the use of personal protective equipment, hand hygiene, procedures, environmental cleaning, or triage.


About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control ( covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

About APIC
APIC's mission is to create a safer world through prevention of infection. The association's more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at Follow APIC on Twitter: and Facebook: For information on what patients and families can do, visit APIC's Infection Prevention and You website at

Notes for editors
"Middle East respiratory syndrome coronavirus: Implications for health care facilities," by Helena C. Maltezou and Sotirios Tsiodras appears in the American Journal of Infection Control, Volume 42, Issue 12 (December 2014).

Helena C. Maltezou, MD, PhD (Corresponding Author)

Department for Interventions in Health-Care Facilities
Hellenic Center for Disease Control and Prevention
Athens, Greece

Sotirios Tsiodras, MD, PhD
Fourth Department of Internal Medicine
University of Athens Medical School, Attikon University Hospital
Athens, Greece

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