While I am likely dating myself, when the first case of MERS was reported to hit the US, followed by a second, and then one emerged in Canada the scene from Poltergeist where Carol Anne Freeling (played by Heather O'Rourke) say's "They're Here!" instantly jumped into my head. Only for MERS - it was more like "It's Here!"
It was almost exactly a year ago in the "SARS - Was round 2 ten years in the making?" blog that we introduced MERS to our Talk Clean To Me followers. At that time, there were 18 deaths associated with the virus. One year later, after a significant spike in cases since March there have now been at least 536 confirmed cases with 145 deaths and while most of the infections are associated with countries in the Middle East cases have been confirmed in numerous countries across Europe and now North America.
But what does this mean to IP's from across North America trying to implement an infection prevention and control program to ensure their facility is protected? Well, I can say from the 6 hours I spent in the ER with my son yesterday, signs are posted to let people know that visitors are being limited and that if you have recently travelled to the Middle East to please let the triage nurses know. But what about the environmental hygiene protocol? Are IPs on the search for products with claims against MERS? I truly hope not, for they will not find it.
Why? Well, mainly for the reason that the CDC will likely not allow any labs in the US to have access to the MERS virus for at least a year and perhaps longer. In talking to one of the labs I was told that "unfortunately, like the SARS virus, MERS is highly pathogenic and we will not be able to acquire the virus because of that. The closest virus we have available is Human Coronavirus."
However, all is not lost, the EPA does have the ability to invoke the Emerging Pathogen Policy for which MERS is the ideal situation, but as MERS has not yet reached Pandemic levels the EPA is not yet willing to invoke it. While the cases are increasing rapidly and the mortality rate is alarming the reasoning is probably based in part on WHO's recent announcement that while the sharp rise in MERS-CoV cases and the impact of the disease are concerning, it does not yet meet the definition of a public health emergency of international concern. In weighing the sharp increase in cases since March, especially in Saudi Arabia and the United Arab Emirates, it has been determined that suboptimal infection control practices, made worse by severe overcrowding in emergency departments, have led to a number of secondary infections in hospitals.
So where does that leave those of us in North America where we too appear to have seen secondary transmission to healthcare staff? Well hopefully, the EPA will come to its senses and invoke the Emerging Pathogen Policy before too many more MERS cases pop up. In the meantime, we can learn what the policy entails and perhaps put it to use on our own.
The Emerging Pathogen Policy is a guidance document that utilizes an organism hierarchy to identify effective products for use with emerging pathogens and to permit registrants to make limited statements against such pathogens (interesting...Lee and I have been saying this is what should be used at all times!). Microorganisms can be ranked with respect to their susceptibility to inactivation by disinfectants using the Spaulding Classification where the most difficult to inactivate (e.g., bacterial endospores) are at the top of the model. In contrast, the lowest tier includes those microorganisms generally considered to be most susceptible to inactivation (e.g., enveloped viruses) using virtually any disinfectant routinely used in hospitals. Of importance is the fact that the Emerging Pathogen Policy applies only to emerging enveloped and non-enveloped viruses.
To help you provide proof of the rationale you can use for including what disinfectant to use, the following are the criteria the EPA uses for antimicrobial products subject to the Emerging Pathogen Policy:
1. Hospital and general disinfectant products registered with EPA;
2. Have acceptable efficacy data previously submitted to and reviewed by the Agency for an enveloped and/or non-enveloped virus (e.g., HIV and/or Rhinovirus, respectively);
3. For an emerging small non-enveloped virus, have at least one small non-enveloped virus previously listed on the products label. (e.g. Poliovirus);
4. For an emerging large non-enveloped virus, have either one small or large non-enveloped virus previously listed on the product's label. (e.g. Adenovirus);
5. For an emerging enveloped virus, have at least one non-enveloped or enveloped virus previously listed.
HEY! MERS is a Coronavirus..an ENVELOPED virus - if you follow the above rationale, as long as the disinfectant you are currently using has at least a non-enveloped and/or enveloped virus already listed on the label you can consider yourself covered and if the product already carries a claim against Human Coronavirus even better!