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

• Mental health support for health care workers is an important factor in increasing resilience and cooperation within the workforce. How can decision-makers in health care organizations manage crises better? Rapid and widespread pandemics pose high risks to mortality, health systems, and economies, locally, nationally and globally. Middle East Respiratory Syndrome (MERS), caused by the newly described coronavirus (MERS-CoV), is one such major emerging health concern. Death occurs in around 65% of all patients, who contract MERS-CoV, resulting from severe acute respiratory infection and multi-organ failure. 1 MERS-CoV outbreaks have occurred in 26 countries across the Middle East, Africa, Europe, Asia, and North America, 3 ,4 yet successful management of MERS-CoV outbreaks is very challenging because, not only does infection most commonly occur in health care workers (HCW) 2 , knowledge of both the causes of the virus and its treatment is preliminary. 3, 4, 5, 6 Most outbreaks to date are attributed to low-adherence to infection control (IC) practices, crowded emergency departments (ED), and slow responsiveness to outbreaks. 7 Consequently, to assist organizational preparedness 8 , more knowledge is needed to guide management of MERS-CoV infection outbreaks. This is especially important given the wide breadth of response needed, which can encompass improving IC practices to providing psychological support to HCWs. 9 A major new outbreak of the MERS-CoV occurred at the King Abdulaziz Medical City-Riyadh (KAMC-R) 10 ; a large teaching hospital and university center in the Kingdom of Saudi Arabia in June 2015. 11 The outbreak resulted in 130 cases of infection (53% mortality rate), directly or indirectly involved 9000 HCWs at the site, and affected all major departments at the institution (table 1) .