Hospital details rapid response to MERS patient

A combination of operational protocols and access to various technologies helped health officials at the hospital taking care of the first MERS patient in the U.S. respond quickly to the case and isolate the patient, they say.

The major lesson from this first MERs experience in the U.S. for other healthcare providers is “to think about MERS you really need to get a good travel history,” said Dr. Daniel Feikin, the CDC medical epidemiologist who is leading the investigation of the reported case. “The key is getting that travel history right up front when you're interviewing the patient and then as soon as you suspect MERS—even before you do the testing—you should make sure you have that patient on isolation precautions so they don't spread to any other patients or healthcare workers.“

Patients who enter the emergency room at Community Hospital in Munster, Ind., with symptoms such as fever, cough or diarrhea are routinely kept in private triage rooms to prevent the risk of infectious diseases spreading, said Dr. Alan Kumar, chief medical and information officer for the hospital. Such was the case April 28 when the patient, who has been identified as the first reported case of MERS in the country, came in.

Rather serendipitously, Kumar said, the patient was taken to one of the hospital's negative airflow rooms—an isolation room with a ventilation system designed to prevent air from flowing to other parts of the hospital. “So, already, risk of this spreading was low,” Kumar said.

Next, the infectious disease team was brought in to interview the patient. Located about 50 miles from Chicago's O'Hare International Airport, the hospital often receives international patients, so travel history is routinely included within the conversation.

“We learned information that presented a risk,” Kumar said. Samples were taken and sent to the Indiana State Department of Health on April 30, and from there, they were later sent to the Centers for Disease Control and Prevention in Atlanta.

As they awaited the results, hospital staffers turned to technology to quickly gather information on who else may have been exposed. They looked at electronic health records and pulled video surveillance from the emergency department for the 24-hour period before the patient was placed in isolation. They also pulled logs of tracer tags worn by staff, a sort of internal GPS system showing where any individual staff member is located within a given period of time.

“Operationally, it was hugely important to be able to understand workflow,” said Don Fesko, CEO of the hospital. When the CDC confirmed the patient had MERS about 12:30 p.m. Central on May 2, hospital staff was ready to respond appropriately. “We could easily take anyone who was on duty, out of duty, and quickly explain to them what was going on.”

About 50 employees exposed to the patient before he was put in isolation were removed from duty. None have tested positive for MERS, and they are expected to return to work by the end of next week.

The hospital, the state health department and the CDC say the collaborative efforts of all entities involved led to the successful isolation of the case. However, the CDC continues to stress that viruses don't respect borders and future cases of the disease on U.S. soil are likely inevitable.

All hospitals should have their antennas up, especially those in or near a big metropolitan areas, said Feikin. Physicians in Munster, Ind. were able to rapidly put the pieces together using what they knew about MERS and the patient's travel history. Their efforts to prevent the spread of the disease were a real success, he said.

Follow Sabriya Rice on Twitter: @MHsrice