Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study

Al Knawy, Bandar Abdulmohsen; Al-Kadri, Hanan M F; Elbarbary, Mahmoud; Arabi, Yaseen; Balkhy, Hanan H; Clark, Alex

Management of the MERS-CoV outbreak at KAMC-R was widely recognized by staff as a serious outbreak of local and national significance. While the outbreak was controlled successfully in 6 weeks, progress in management was inhibited by a lack of institutional readiness to implement infection control measures and reduce patient flow, low staff morale and high anxiety. Effective management was promoted by greater involvement of all staff in sharing learning and knowledge of the outbreak, developing trust and team work, and fostering collective leadership. Future major infection control crises could be improved via measures to strengthen these areas, as well as better coordination of media management and pro-active staff counseling 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r p e e r r e v i e w o n l y 18 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r p e e r r e v i e w o n l y 19 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 In addition to the IDEP plan, which was established in 2013 with the detailed MERS-CoV flowcharts, a more strict and explicit triage process was established to ensure early identification of suspected MERS-CoV cases. This was added as the first layer of the patient triage process and implemented in the newly established drive-through system to the ER, and at the entrances of the ACC. Once a patient has entered the main ER, a second screening would take place to identify any possible cases that may have been missed by the first process. Two new teams were formed: CMT, a medical team managing all admitted patients with respiratory illness and CPRT, an outreach team responsible to ensure proper location, testing, transfer, discharge and consultation for suspected and confirmed MERS cases.