Nosocomial infection is like a chain reaction,starting with one case most of the time then spreading through different types of vectors: first of them is human vector, mostly health care workers (HCW) and relatives/visitors inside the premises; other vectors for MERS have been previously identified like droplets or fomites, clothes or sheets.

Have a look at the mecanism of nosocomial infection and spreading at community level:Ignore mild and asymptomatic cases at your peril… by Dr Ian Mackay (@MackayIM)

As of September 3rd, there are two nosocomial outbreaks in Riyadh and possibly new clusters emerging in Najran and Jeddah/Madinah. For more details, refer to Riyadh #MERS outbreak diary

Breaking the spread means to be able to put in place measures of containment to prevent MERS risk exposure. It is supposedly underlying that:

1. infected People are diagnosed/tested,isolated and treated  by well trained and protected HCW;
2. Medical waste are identified as bio Hazmat and destroyed/burnt;
3. Relatives and visitors must be limited and well informed about the risk of contamination and precautions to be taken while at hospital including hand sanitation;
4. Housekeeping,hygiene must be reinforced with adequate means.
5. Rooms, wards, department, especially Emergency must be cleaned and sterilized on a regular basis, including ventilation, air conditioner and filters.

Starting in early August, the nosocomial MERS outbreak in KAMC is still ongoing despite mitigation measures and shut down of several departments including ER and non urgent surgical procedures or outdoor services.

HCW continue to be contaminated despite standard precautions including personal protective equipment which unfortunately demonstrates a failure in the Infectious control prevention. AS for Ebola in West Africa, questions are about the awareness and training of the medical staff and their ability to perform safely their duty.

The high risk areas are related to wards taking care of elderly ill people with medical underlying conditions, ICU. The pre-existing poor medical conditions lead to a high CFR; the entire recent deaths (24 and 25/08/2015) occurred on this category of infected People!

These findings are very close to the action plan launched by KSA MOH:

Several Preventive Actions to Avert Onset or Outbreak of MERS-CoV

On Sunday sept.6th, 25 Mers-CoV recorded in Riyadh including many HCW. We are now close to the numbers of South Korea (186); we have reached 137 as of today…

But do not underestimate the key role and responsibility of healthy carriers or asymptomatic-but tested positive cases able to spread MERS Coronavirus all around them at home, at work, at the hospital. They are not recorded as MERS cases by WHO…

For a more comprehensive review of MERS Coronavirus please refer to:

Whether MERS-CoV spreads or stops is entirely up to the hospitals… by Ian Mackay