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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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
MERS-CoV
Screening & triaging Infection Prevention & Control Stockpile for PPE Hospital facilities Hospital Admission Case Notification Laboratory diagnosis
Hospital preparedness in managing mers-cov
Medical Development Division,Ministry of Health Malaysia
MERS-CoV
shall be implemented in the Outpatient Department (OPD) and Emergency Department (ED) in all hospitals
Screening and 'triaging'
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
NEGERI PENGERUSI JAWATAN HOSPITAL
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
NEGERI PENGERUSI JAWATAN HOSPITAL
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
MERS-CoV
Flowchart of specimen collection for mers-cov laboratory
diagnosis
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
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
Medical Development Division,Ministry of Health Malaysia
MERS-CoV
THANK YOU
Medical Development Division,Ministry of Health Malaysia
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