Al-Dorzi Hasan M, Aldawood Abdulaziz S, Khan Raymond, Baharoon Salim, Alchin John D, Matroud Amal A, Al Johany Sameera M, Balkhy Hanan H, Arabi Yaseen M
ICU2 and TICU, Intensive Care Department, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Intensive Care Department, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Ann Intensive Care. 2016 Dec;6(1):101. doi: 10.1186/s13613-016-0203-z. Epub 2016 Oct 24.
Middle East respiratory syndrome coronavirus (MERS-CoV) has caused several hospital outbreaks, including a major outbreak at King Abdulaziz Medical City, a 940-bed tertiary-care hospital in Riyadh, Saudi Arabia (August-September 2015). To learn from our experience, we described the critical care response to the outbreak.
This observational study was conducted at the Intensive Care Department which covered 5 ICUs with 60 single-bedded rooms. We described qualitatively and, as applicable, quantitatively the response of intensive care services to the outbreak. The clinical course and outcomes of healthcare workers (HCWs) who had MERS were noted.
Sixty-three MERS patients were admitted to 3 MERS-designated ICUs during the outbreak (peak census = 27 patients on August 25, 2015, and the last new case on September 13, 2015). Most patients had multiorgan failure. Eight HCWs had MERS requiring ICU admission (median stay = 28 days): Seven developed acute respiratory distress syndrome, four were treated with prone positioning, four needed continuous renal replacement therapy and one had extracorporeal membrane oxygenation. The hospital mortality of ICU MERS patients was 63.4 % (0 % for the HCWs). In response to the outbreak, the number of negative-pressure rooms was increased from 14 to 38 rooms in 3 MERS-designated ICUs. Patients were managed with a nurse-to-patient ratio of 1:0.8. Infection prevention practices were intensified. As a surrogate, surface disinfectant and hand hygiene gel consumption increased by ~30 % and 17 N95 masks were used per patient/day on average. Family visits were restricted to 2 h/day. Although most ICU staff expressed concerns about acquiring MERS, all reported to work normally. During the outbreak, 27.0 % of nurses and 18.4 % of physicians working in the MERS-designated ICUs reported upper respiratory symptoms, and were tested for MERS-CoV. Only 2/196 (1.0 %) ICU nurses and 1/80 (1.3 %) physician tested positive, had mild disease and recovered fully. The total sick leave duration was 138 days for nurses and 30 days for physicians.
Our hospital outbreak of MERS resulted in 63 patients requiring organ support and prolonged ICU stay with a high mortality rate. The ICU response required careful facility and staff management and proper infection control and prevention practices.
中东呼吸综合征冠状病毒（MERS-CoV）已引发多起医院内疫情，其中包括沙特阿拉伯利雅得一家拥有940张床位的三级护理医院——阿卜杜勒阿齐兹国王医疗城发生的一次重大疫情（2015年8月至9月）。为吸取经验教训，我们描述了针对此次疫情的重症监护应对措施。
本观察性研究在重症监护科进行，该科室涵盖5个重症监护病房，共有60个单人病房。我们定性并在适当时定量描述了重症监护服务对此次疫情的应对情况。记录了感染中东呼吸综合征的医护人员的临床病程和结局。
疫情期间，63例中东呼吸综合征患者被收治到3个指定的中东呼吸综合征重症监护病房（最高普查人数为2015年8月25日的27例患者，最后一例新病例为2015年9月13日）。大多数患者出现多器官功能衰竭。8名医护人员感染中东呼吸综合征需要入住重症监护病房（中位住院时间 = 28天）：7人发展为急性呼吸窘迫综合征，4人接受俯卧位治疗，4人需要持续肾脏替代治疗，1人接受体外膜肺氧合治疗。重症监护病房中东呼吸综合征患者的医院死亡率为63.4%（医护人员为0%）。针对此次疫情，3个指定的中东呼吸综合征重症监护病房的负压病房数量从14间增加到38间。患者的医护配比为1:0.8。加强了感染预防措施。作为替代指标，表面消毒剂和洗手液的消耗量增加了约30%，平均每位患者每天使用17个N95口罩。家属探访限制为每天2小时。尽管大多数重症监护病房工作人员对感染中东呼吸综合征表示担忧，但所有人都报告正常上班。疫情期间，在指定的中东呼吸综合征重症监护病房工作的护士中有27.0%、医生中有18.4%报告出现上呼吸道症状，并接受了中东呼吸综合征冠状病毒检测。只有2/196（1.0%）的重症监护病房护士和1/80（,1.3%）的医生检测呈阳性，病情较轻且已完全康复。护士的总病假时长为138天，医生为30天。
我们医院爆发的中东呼吸综合征导致63例患者需要器官支持，在重症监护病房的住院时间延长，死亡率很高。重症监护应对措施需要对设施和人员进行仔细管理，并采取适当的感染控制和预防措施。
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