중동호흡기 증후군 환자 간호에 참여한 간호사의 외상 후 스트레스와 영향요인
대상자의 외상 후 스트레스는 평균 14.08±16.81점으로, 하위영역에서 과각성 3.02±5.00점, 회피 3.39±5.01점, 침습 4.55±4.16점, 수면장애 및 정서적 마비, 해리증상 3.12±3.73점으로 나타났다. 외상 후 스트레스장애 군은 22.2%, 부분 외상 후 스트레스장애 군은 27.8%였다. 대상자의 외상 후 스트레스에 영향을 미치는 요인으로는 직위, 정신적 직무요구, 신체적 직무요구, 상 사지지가 통계적으로 유의하였고, 13%의 설명력을 보였다. 간호사의 외상 후 스트레스 를 관리하기 위해서는 정신적 직무요구를 반영하고 신체적 직무요구를 고려해야하며 적절한 지지를 제공해야 하겠다.
출처 및 원문:
보건사회연구 36(4), 2016, 488-507 Health and Social Welfare Review 488 http://dx.doi.org/10.15709/hswr.2016.36.4.488
Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea, 2015
The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea started from the index case who developed fever after returning from the Middle East. He infected 26 cases in Hospital C, and consecutive nosocomial transmission proceeded throughout the nation. We provide an epidemiologic description of the outbreak, as of July 2015.
Epidemiological research was performed by direct interview of the confirmed patients and reviewing medical records. We also analyzed the incubation period, serial interval, the characteristics of superspreaders, and factors associated with mortality. Full genome sequence was obtained from sputum specimens of the index patient.
A total of 186 confirmed patients with MERS-CoV infection across 16 hospitals were identified in the Republic of Korea. Some 44.1% of the cases were patients exposed in hospitals, 32.8% were caregivers, and 13.4% were healthcare personnel. The most common presenting symptom was fever and chills. The estimated incubation period was 6.83 days and the serial interval was 12.5 days. A total of 83.2% of the transmission events were epidemiologically linked to five superspreaders, all of whom had pneumonia at presentation and contacted hundreds of people. Older age [odds ratio (OR) = 4.86, 95% confidence interval (CI) 1.90–12.45] and underlying respiratory disease (OR = 4.90, 95% CI 1.64–14.65) were significantly associated with mortality. Phylogenetic analysis showed that the MERS-CoV of the index case clustered closest with a recent virus from Riyadh, Saudi Arabia.
A single imported MERS-CoV infection case imposed a huge threat to public health and safety. This highlights the importance of robust preparedness and optimal infection prevention control. The lessons learned from the current outbreak will contribute to more up-to-date guidelines and global health security.
- Middle East respiratory syndrome
Resource and full paper: http://ac.els-cdn.com/S221090991530045X/1-s2.0-S221090991530045X-main.pdf?_tid=f7981d34-7c47-11e5-9ce7-00000aacb362&acdnat=1445908604_b8f3e7f5c6775260849bfc402f2b7759
Public trust in Korean officials was already low after a perceived bungled response to the sinking of the ferry MV Sewol last year, which killed more than 300 people, many of them secondary-school pupils. When MERS struck, the authorities foolishly declined to identify the affected hospitals publicly, allowing rumours — amplified by social media — to fill the space. This faltering start was unfortunate because the government did get its act together soon after.
Source: Nature http://www.nature.com/polopoly_fs/1.18082!/menu/main/topColumns/topLeftColumn/pdf/523502a.pdf
공중보건 위기관리 대응과 소통체계 구축: 중동호흡 기증후군 사태의 경험과 교훈
최 재 욱·김 경 희·문 지 원 ·김 민 수
Public health crisis response and establishment of a crisis communication system in South Korea: lessons learned from the MERS outbreak
Jae Wook Choi, MD1 · Kyung Hee Kim, PhD · Jiwon Monica Moon · Min Soo Kim
It is widely believed that effective communication is critical for the containment of the spread of emerging infectious diseases. Various media outlets and studies have pointed out communication failure as one of the key components that contributed to the wide and rapid spread of Middle East respiratory syndrome coronavirus in South Korea. To address these concerns, we first outline the definitions of risk and crisis communication and why they are important. We then illustrate communication models and guidelines utilized in three organizations (World Health Organization, US Centers for Disease Control and Prevention, and UK Public Health England) for health or disaster control. By analyzing the current guidelines for infectious diseases in South Korea and they were actually applied during the Middle East respiratory syndrome situation, we will assess what went wrong and what went right. Finally, we will suggest various measures that will help to ensure similar tragedies do not happen again. Key Words: Coronavirus infections; Communicable diseases; Risk communication; Crisis communication
한국 중동호흡기증후군 감염에 대한 응급의료 대응체계
이 강 현
연세대학교 원주의과대학 응급의학교실
Emergency medical services in response to the middle east respiratory syndrome outbreak in Korea
Kang Hyun Lee, MD
Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
After the 15 days from the first confirmed case of Middle East respiratory syndrome (MERS) in South Korea on May 20, 2015, the MERS infected case from emergency room (ER) was recognized. I provide the review of characteristics and prevention plan of re-outbreak of a MERS coronavirus at the ER in South Korea. Emergency medical services-related infections with MERS coronavirus have been reported 91 cases (49%) of total 186 cases in South Korea. The first patient was diagnosed with the ER and spent at least 3 days in a busy ER until he was admitted to an isolated room. The causes of MERS’s spreading in ER are mainly due to emergency department (ED) overcrowding, long ED stay time, improper infection control system in ED, and a failure of emergency medical service coordination system in South Korea. Early and rapid detection of suspected infected patients with communicable diseases along with appropriate infection control system in ED, reducing the ED overcrowding and ER stay time would help to prevent the disease transmission in ED. Key words: Middle East respiratory syndrome coronavirus; Emergency medical services; Infection; Emergency room
Source and original: http://www.jkma.org/Synapse/Data/PDFData/0119JKMA/jkma-58-611.pdf
중동호흡기증후군 사태 이후 병원감염관리를 강화하기 위한 의료정책과 의료이용문화 개선
서울대학교 의과대학 의료관리학교실
Healthcare policy and healthcare utilization behavior to improve hospital infection control after the Middle East respiratory syndrome outbreak
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in South Korea in May 2015 revealed that the Korean healthcare system and hospitals are highly vulnerable to hospital-spread infections. In a short period of time, MERS-CoV infection spread widely across Korea due to the unique characteristics of the Korean healthcare system including 1) hospitals with limited infection control capabilities, 2) a heavy dependency on private caregivers due to a nursing shortage, 3) emergency department overcrowding, and 4) healthcare-related patient behaviour such as hospital shopping. To prevent future outbreaks of emerging infectious diseases similar to MERS-CoV, the Korean healthcare system should be reformed and healthcare-related patient behaviour must change. To improve the performance of hospital infection control, the National Health Insurance service should pay more for hospital infection control services and cover private patient rooms when medically necessary, including for infectious disease patients. To reduce risks of hospital infection related to private caregiving, the nurse staffing level should be increased and hospitals should take full responsibility for inpatient nursing care. To reduce hospital shopping, the National Health Insurance service should introduce a differential fee schedule which pays more when primary care providers care for patients with common conditions and tertiary care providers care for patients with severe conditions. To incentivize patients for appropriate health care use, lower patient out-of-pocket payments should be combined with a differential provider fee schedule. Key Words: Infection control; Nursing; Emergency department overcrowding; Primary health care; Healthcare utilization behavior.
Source and original: http://www.jkma.org/Synapse/Data/PDFData/0119JKMA/jkma-58-598.pdf
중동호흡기증후군 사태의 교훈 최 재 욱
고려대학교 의과대학 예방의학교실, 환경의학연구소, 대한의사협회 의료정책연구소
Lessons learned from Middle East respiratory syndrome coronavirus cluster in Korea
Jae Wook Choi, MD
Department of Preventive Medicine, Korea University College of Medicine, Institute for Occupational and Environmental Health, Korea University, Research Institute for Healthcare Policy, Korean Medical Association, Seoul, Korea
2015년 5월 20일 국내에서 중동호흡기증후군(Middle East respiratory syndrome, MERS; 메르스) 확진 환자가 처음 발생한 것을 시작으로 7월 6일 현재 확진 환자 1,860명, 사망자 33명이 발생하였다. 사우디아라비아의 메르스 코 로나바이러스 발생 이후 우리나라는 공식적으로 가장 많은 확진 환자가 발생한 국가이며 메르스 코로나바이러스 클러 스터가 병원을 중심으로 발생하여 우리나라의 감염병관리 역량의 부실을 전 세계에 보여주는 계기가 되었다. 이번 사태는 메르스 바이러스에게 낙타보다 대한민국 보건의료체 계가 더 좋은 숙주라는 사실을 확인시켜 주었다는 지적과 같 이 우리 사회의 전반적 보건의료체계 문제점이 드러났다.
Source and original: http://www.jkma.org/Synapse/Data/PDFData/0119JKMA/jkma-58-595.pdf
중동호흡기증후군 사태와 우리나라를 위한 감염병 관리체계
전 병 율 | 연세대학교 보건대학원
Middle East respiratory syndrome outbreak and infectious disease control in Korea Byungyool Jun, MD Graduate School of Public Health, Yonsei University, Seoul, Korea
After the first diagnosis of Middle East Respiratory Syndrome (MERS) in Korea on May 20th, 2015, significant fear and anxiety surrounding infectious diseases has emerged in the community. Using the recent MERS case in Korea as an example, we hope to identify problems in the governance of infectious diseases management and to suggest improvements. Korean Health authorities have demonstrated inadequacy in several areas in preparing for and responding to emerging infectious diseases threats. There is lack of monitoring or education regarding prevention, and there are no systems for monitoring people visiting or residing in infectious disease risk areas. Moreover, operating a continuous monitoring system by the Korea Centers for Diseases Control and Prevention (KCDC) is very difficult due to the lack of permanent support for a clear command and control system and specialists for responding to public health emergencies. The MERS situation has highlighted the importance of risk communication during public health crises. In order to advance the governance of infectious disease management, the KCDC should be improved as a priority. The Korean government should nurture the development of professional personnel who can respond to global health crises. Furthermore, the expansion of medical isolation facilities within hospital wards and emergency departments is needed. However, the cooperation of the public is a critical factor in this campaign. The public should be educated about appropriate action during disasters and public health crises, including strategies for practicing this action in everyday life. Key Words: Coronavirus infections; Communicable disease control; Communicable disease prevention; Governance
Source and original: JKMA http://www.jkma.org/Synapse/Data/PDFData/0119JKMA/jkma-58-590.pdf
The Joint Mission recommended maintaining the status quo of efforts. The Director General convened the 9th meeting of International Health Regulation (IHR) Emergency Committee regarding MERS-CoV on June 17, 2015. Although neither a state of emergency nor travel limitation was recommended to be imposed upon the ROK, the “large and complex” was described in the following manner
1. A lack of awareness of MERS among the health care workers and the general public;
2. Suboptimal infection prevention and control measures in the hospitals;
3. Close and prolonged contact of infected MERS patients in crowded emergency rooms and multi-bed rooms in hospitals;
4. The problematic practice of seeking care at multiple hospitals (“shopping for doctors”);
5. The custom of many visitors or family members staying with infected patients in the hospital rooms facilitating the secondary spread of infections